New York Attorney General Letitia James' office ranks among the worst in the nation for criminally prosecuting Medicaid fraud, according to an analysis by The Empire Center for Public Policy. The analysis, which used federal data, indicates that during James' tenure as attorney general from 2019 to 2025, the state ranked 49th for criminal investigations per billion dollars of Medicaid spending.
New York also ranked 51st out of all states and Washington D.C. for indictments and convictions per billion dollars of Medicaid spending, according to Empire Center fellow Bill Hammond. These findings come as New York spends $124 billion on Medicaid annually, the highest per resident among the 50 states in fiscal year 2024 and 77% above the national average.
The federal government, which contributes more than half of the funding for Medicaid, has prioritized combating fraud, waste, and abuse to control costs. The U.S. Department of Health and Human Services Inspector General Thomas March Bell previously informed James that the state's Medicaid Fraud Control Unit's federal funding would be suspended through at least September 30 due to insufficient criminal indictments and convictions.
"As a result of this leadership failure and poor decision making—and with billions of dollars at stake and millions of people expecting safe care for their families—the New York MFCU has been ineffective in fighting criminal cases involving Medicaid fraud or abuse or neglect of Medicaid patients," Bell wrote in a June 30 letter to James.
While James' office has disputed the assertion of lax enforcement, Hammond concluded the federal criticism was largely accurate. "A review of the available statistics, however, suggests that Bell’s criticism is well founded," Hammond stated. "The performance of James’ MFCU – when adjusted for the scale of New York’s $124 billion Medicaid program – ranks among the worst in the US on a range of benchmarks."
The analysis found that only Alabama and Oregon ranked worse than New York for overall Medicaid investigations, while Hawaii led the nation in such probes. Mississippi reported the highest overall indictment and conviction rate, and Nevada topped the list for the best fraud indictment and fraud conviction rate specifically.
New York's per-resident spending on Medicaid was $4,942 in fiscal year 2025, significantly higher than Kentucky's $3,989, the next highest. California followed at $3,984 per resident. In contrast, more populous states like Texas and Florida spent considerably less per resident on Medicaid, at $1,579 and $1,536, respectively.
The effectiveness of Medicaid fraud enforcement has become a point of contention in the upcoming election, as James seeks re-election. Her Republican opponent, Saritha Komatireddy, has criticized James' record, vowing to add prosecutors and recover stolen Medicaid funds.
James' office defended its record, stating that New York recovers more funds for Medicaid than almost any other state, securing over $627 million since 2019. A spokesperson for James asserted that the federal administration's decision to play politics with funding will embolden criminals and jeopardize vulnerable New Yorkers. The office highlighted that New York was among the top 10 states for total funds recovered annually since 2019, leading the nation in fiscal year 2020 with $181 million recovered.
Recent criminal cases prosecuted by the office in the last month include arrests related to a fraudulent medical clinic in Queens, a medical supply company owner accused of stealing $2.5 million, and an individual charged with stealing $9 million through a fake billing scheme for eye surgeries.
However, critics argue that the AG's office's defense relies heavily on civil recoveries, while the federal inspector general's concerns primarily address weak criminal enforcement. Additionally, the AG's statistics reportedly focus on gross dollar amounts without adjusting for New York's high Medicaid program costs. As a percentage of overall spending, New York's criminal recoveries ranked 38th in 2025, and 49th for James' entire term. The analysis also noted a 50% drop in New York's Medicaid Fraud Control Unit investigative activity between 2020 and 2025, compared to a 19% dip nationwide.