New York Dead Last in Medicaid Fraud Prosecutions Under Letitia James—Billions at Stake

New York ranks dead last in the nation for prosecuting Medicaid fraud criminals—a stunning failure that exposes Attorney General Letitia James’ office as fundamentally broken when it comes to protecting taxpayer dollars from theft.

The damning numbers tell an unambiguous story of failure.

According to an independent analysis of federal data, New York placed 51st out of all states and Washington D.C. for both indictments and convictions per billion dollars of Medicaid spending during James’ tenure from 2019 to 2025. The state barely fared better on criminal investigations, ranking 49th in the nation.

This isn’t just bureaucratic underperformance—it’s a betrayal of taxpayers footing the bill for the nation’s most bloated Medicaid system.

New York hemorrhages $124 billion annually on Medicaid, the highest per-resident spending of any state and a staggering 77% above the national average. At $4,942 per resident, New York’s Medicaid spending dwarfs even California’s, despite the Golden State having double the population.

The contrast with well-governed Republican states is stark. Texas spends just $1,579 per resident on Medicaid. Florida manages with $1,536 per resident. Yet James expects New Yorkers to accept that recovering fraud losses is somehow more challenging in New York than in states spending a fraction of the amount.

Federal Funding Frozen Over “Leadership Failure”

The Trump administration delivered a devastating rebuke to James’ office in June, freezing $60 million in federal funding for New York’s Medicaid Fraud Control Unit.

U.S. Department of Health and Human Services Inspector General Thomas March Bell didn’t mince words in his letter to James, citing “leadership failure and poor decision making” that left the unit “ineffective in fighting criminal cases involving Medicaid fraud or abuse or neglect of Medicaid patients.”

With billions of dollars at stake and millions of vulnerable New Yorkers depending on safe care, Bell concluded James’ operation simply isn’t getting the job done.

The independent Empire Center for Public Policy analysis confirms Bell’s assessment is accurate.

“A review of the available statistics suggests that Bell’s criticism is well founded,” concluded Empire Center fellow Bill Hammond. “The performance of James’ MFCU—when adjusted for the scale of New York’s $124 billion Medicaid program—ranks among the worst in the U.S. on a range of benchmarks.”

The Numbers Don’t Lie

Only Alabama and Oregon performed worse than New York on overall Medicaid fraud investigations. Mississippi achieved the highest overall indictment and conviction rates, while Nevada topped the charts for fraud-specific prosecutions.

Hawaii led the nation in launching fraud investigations—demonstrating that effective enforcement is possible regardless of geography.

James’ investigative activity has collapsed on her watch. From 2020 to 2025, investigations of all types plummeted 50% in New York, compared to just a 19% decline nationwide.

This represents a conscious choice to deprioritize criminal enforcement.

James’ Misleading Defense

Predictably, James dismissed the federal government’s findings as a “partisan hit job” and pointed to $627 million recovered since 2019.

The deflection is intellectually dishonest.

James’ statistics focus almost entirely on civil recoveries—regulatory settlements and fines—while deliberately obscuring her office’s abysmal criminal prosecution record. Civil actions don’t put criminals behind bars or deter future fraud the way criminal prosecutions do.

When adjusted for New York’s massive Medicaid spending, those recovery numbers tell a different story. As a percentage of overall spending, New York’s 2025 civil recoveries ranked just 10th nationwide. Criminal recoveries? A dismal 38th place.

Over James’ entire tenure from 2019 through 2025, New York’s civil recoveries ranked 16th as a percentage of spending. Criminal recoveries languished near the bottom at 49th.

James boasts that 69 of 115 criminal convictions were “high impact” cases targeting executives and corporations. That sounds impressive until you realize it’s just 11.5 high-impact convictions per year in a state spending $124 billion annually on Medicaid.

A Campaign Issue Republicans Can Win

This scandal has rightfully become a central issue in the Attorney General race.

Republican candidate Saritha Komatireddy, a former federal prosecutor who knows how to actually convict criminals, delivered a withering assessment of James’ record.

“New Yorkers are getting ripped off every day, and Letitia James isn’t doing anything about it,” Komatireddy said.

She’s committed to adding 20 criminal prosecutors to the office and recovering at least $1 billion in stolen Medicaid funds during her first term—money she pledges to return directly to New Yorkers through a “crime tax refund.”

“Every dollar stolen from Medicaid is a dollar stolen from New York taxpayers, and means that patients, seniors, and children in New York have been deprived of critical medical care,” Komatireddy explained.

The contrast couldn’t be clearer. James has presided over a 50% collapse in investigations while Medicaid spending has continued its upward trajectory. Komatireddy offers concrete solutions: more prosecutors, aggressive criminal enforcement, and accountability for the billions being stolen.

The Real Crime Tax

New Yorkers already pay some of the highest taxes in America. They’re entitled to know those tax dollars aren’t being funneled into the pockets of Medicaid fraudsters while their Attorney General looks the other way.

The federal government provides more than half the funding for New York’s bloated Medicaid program. Cracking down on fraud, waste, and abuse isn’t just good policy—it’s a fiscal imperative as Washington seeks to rein in runaway entitlement spending.

James has spent her tenure as AG filing lawsuits against the Trump administration and conservative organizations while fraudsters have operated with near impunity in her own backyard.

The Inspector General’s decision to freeze federal funding isn’t political persecution—it’s appropriate accountability for an office that has spectacularly failed its basic mission.

New Yorkers deserve better than last-place performance on criminal prosecution of Medicaid fraud. They deserve an Attorney General who prioritizes protecting taxpayer dollars over partisan grandstanding.

The data is clear, the federal assessment is accurate, and the solution is straightforward: New leadership that will actually prosecute criminals stealing from one of the nation’s most expensive government programs.

Anything less is a continuation of the status quo that has made New York a magnet for Medicaid fraud and left taxpayers holding the bag for billions in stolen funds.