New York Attorney General Letitia James oversees the largest Medicaid program in the country, and one of the worst records for criminally prosecuting the people who steal from it. An independent analysis using federal data found that her Medicaid Fraud Control Unit ranked 49th out of all states and Washington, D.C., for criminal investigations per billion dollars spent, and dead last, 51st, for both indictments and convictions.
The findings, published by the Empire Center for Public Policy, land at a moment when James is already under fire from the Trump administration, which froze $60 million in federal funding for her fraud unit after the HHS Inspector General accused it of failing to secure enough criminal cases. Together, the numbers paint a picture of an attorney general's office that talks tough on fraud recoveries while letting criminal prosecutions wither.
James' office calls the criticism a partisan hit job. But the Empire Center's Bill Hammond, the fellow who conducted the analysis, concluded the opposite: the feds were "mostly correct."
New York's $124 billion Medicaid program is the most expensive in the nation. The state spends $4,942 per resident, 77 percent above the national average of $2,791 and 24 percent more than Kentucky, the next highest at $3,989. The federal government picks up more than half the tab. By any measure, the scale of New York's Medicaid spending demands aggressive fraud enforcement.
Hammond's analysis, reported by the New York Post, adjusted each state's enforcement record for the size of its Medicaid program. When measured that way, James' unit collapsed in the rankings. Only Alabama and Oregon performed worse for overall investigations. Hawaii ranked first for launching probes. Mississippi posted the highest indictment and conviction rates. Nevada topped the list for fraud-specific indictments and convictions.
New York, with more Medicaid dollars at stake than any other state, sat near the bottom on virtually every criminal metric.
The decline happened on James' watch. From 2020 to 2025, investigations of all types, civil and criminal, dropped by 50 percent in New York. Nationwide, the dip was 19 percent. That gap is not a rounding error. It is a collapse in enforcement activity inside the country's biggest Medicaid program.
A spokesperson for James' office pushed back, pointing to raw dollar recoveries. The office said New York has recovered more than $627 million in Medicaid funds since 2019 and ranked among the top ten states for total funds recovered every year during that span. In fiscal year 2020, New York led the nation with $181 million recovered. In fiscal year 2025, the state recovered more than $110 million, fifth most of any state.
The spokesperson also cited criminal convictions, noting that 69 of the MFCU's 115 criminal convictions from 2020 to 2025 were classified as "high impact."
"Every year, New York recovers more funds for Medicaid than almost any other state, securing more than $627 million since 2019. If the federal administration actually wanted to combat fraud, they would be working with our office, just as past administrations from both parties have done."
That framing leans on raw totals. New York should recover more dollars than smaller states, it spends more than any of them. The Empire Center's analysis stripped away that built-in advantage by measuring performance as a share of total Medicaid spending. On that basis, New York's civil recoveries in 2025 ranked 10th. Its criminal recoveries ranked 38th. Over the full span of James' tenure, civil recoveries as a percentage of spending ranked 16th, and criminal recoveries fell to 49th.
Hammond put it plainly in his analysis:
"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."
In other words, James' office is spending the most and catching among the fewest. The raw-dollar defense obscures a per-dollar enforcement record that trails nearly every state in the union.
The Empire Center's findings arrived after HHS Inspector General Thomas March Bell sent a June 30 letter to James accusing the MFCU of failing to secure enough criminal indictments and convictions. Bell did not hold back.
"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."
Fox News reported that the HHS Office of Inspector General denied New York's MFCU its annual recertification on June 30, suspending federal funding effective July 1 through September 30. The unit reported only 53 fraud convictions from 2023 to 2025, the lowest among similar-sized units. The next lowest was 129. New York ranked last in criminal indictments, securing fewer than ten fraud indictments in four of the past five years, compared to more than 100 annually before James took office.
Those are not marginal declines. They represent a structural collapse in the criminal side of the fraud unit's work.
James' office characterized the funding freeze as politically motivated. The spokesperson said the administration's "reckless decision to play politics with critical funding to fight Medicaid fraud in New York will only embolden criminals and put vulnerable New Yorkers at risk." That argument might carry more weight if the enforcement numbers were not already in free fall before the freeze took effect.
The pattern of high-profile Democratic officials facing scrutiny that they dismiss as partisan, only for the underlying record to speak for itself, has become familiar. Similar dynamics played out when other politically charged legal matters unraveled under closer examination.
James is seeking re-election to a third term in November, and the Medicaid fraud debate has handed her Republican challenger a concrete line of attack. Saritha Komatireddy, a former federal prosecutor running for attorney general, seized on the numbers.
"New Yorkers are getting ripped off every day, and Letitia James isn't doing anything about it."
Komatireddy pledged to add 20 criminal prosecutors to the office and vowed to recover at least $1 billion in stolen Medicaid funds during her first term. She framed the enforcement failure in pocketbook terms.
"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."
Whether those promises are achievable remains to be seen. But the underlying critique has teeth: New York's per-dollar criminal enforcement record is objectively weak, and the decline in investigations predates any federal intervention.
James has faced political headwinds from multiple directions. Her standing within the Democratic Party has shown cracks, as recent primary results in New York demonstrated that progressive challengers are gaining ground in her own backyard.
James' office has pointed to recent criminal cases as evidence that it takes enforcement seriously. Last month, the office arrested two people for running a fraudulent medical clinic in Queens that stole over $100,000. Separately, a medical supply company owner was arrested for stealing $2.5 million from Medicaid, and a man was charged in a scheme that stole $9 million through charges for fake eye surgeries.
Those cases are real. They also illustrate the scale of the problem. New York's Medicaid program is a $124 billion operation, the largest in the country, funded heavily by federal taxpayers. A handful of arrests, even significant ones, does not constitute a vigorous enforcement posture when the program is that large and the per-dollar prosecution rate trails nearly every other state.
The broader fiscal environment in New York only sharpens the stakes. With city leaders proposing billions in new taxes, every dollar lost to Medicaid fraud is a dollar that either goes unrecovered or gets backfilled by taxpayers already under strain.
James' office wants the public to focus on total dollars recovered. The Empire Center and the HHS Inspector General want the public to focus on criminal prosecutions per dollar spent. Both metrics matter, but they tell very different stories.
On raw recoveries, New York performs respectably, top ten most years, sometimes first. On criminal enforcement adjusted for the program's size, New York is near the bottom of the barrel. The 50 percent drop in investigations from 2020 to 2025, against a 19 percent national decline, suggests a deliberate or negligent drawdown in enforcement activity, not a statistical quirk.
The HHS Inspector General's letter described it as a "leadership failure." Hammond's analysis called the federal criticism "well founded." James' office called it a partisan attack. The numbers, at minimum, raise serious questions about whether the attorney general's office has treated criminal Medicaid fraud prosecution as a priority.
And $60 million in frozen federal funding is now the price of those unanswered questions. Revelations that undermine the stated priorities of officials, whether in New York or California, have a way of clarifying what was actually happening behind the press releases.
New York taxpayers fund the most expensive Medicaid program in America. They deserve an attorney general who prosecutes the people stealing from it, not one who ranks 51st and calls the scoreboard partisan.