AG Letitia James has some explaining to do on – Latest News
When it comes to policing New York’s sprawling Medicaid program, Attorney General Letitia James has some explaining to do.
As AG, James runs the state’s Medicaid Fraud Control Unit, which is charged with prosecuting those that rip off the taxpayer-funded program or neglect and abuse its susceptible sufferers.
It ought to be a busy place, contemplating New York spends far more per capita on Medicaid than every other state.
Yet on her watch the unit has been posting metrics that vary from lackluster to surprisingly low, particularly when measured in opposition to the dimensions of a $119 billion social program.
James’ document on this high-stakes space now faces scrutiny from two instructions: an audit of MFCU efficiency by the Trump administration, and sharp, well-informed assaults by her Republican challenger, Saritha Komatireddy.
As a two-term incumbent Democrat in a completely blue state, James may get away with ducking her political opponent’s questions.
But she will be able to’t evade the review lately ordered by the inspector basic of the US Department of Health and Human Services, T. March Bell — not, at the very least, with out placing federal assist in jeopardy.
“Noncompliance with your MFCU obligations can take your State’s entire Medicaid program out of compliance,” Bell warned in a May 13 letter to attorneys basic nationwide.
“This means your failure to do your job as head of the MFCU has put all of your State’s Medicaid funds in jeopardy.”
One means or one other, James could have to defend — or at the very least clarify — the underwhelming efficiency of her anti-fraud unit, and that ought to be fascinating to watch.
Federal statistics over the previous 5 years show that New York’s MFCU logged nearly 3,000 investigations for fraud, abuse and neglect, which was the sixth-highest quantity within the nation.
That doesn’t sound so dangerous till you contemplate that New York’s Medicaid finances is the second-highest within the nation.
In phrases of investigations per billion spent, New York’s unit ranked forty eighth out of the 50 states.
It was forty ninth in indictments per billion and fiftieth — useless final — in convictions per billion.
Another troubling signal, as Komatireddy has identified, is that fraud enforcement appears to have trended sharply downward on James’ watch.
Since she turned lawyer basic in 2019, the quantity of annual fraud investigations has dropped 45%, federal information point out; the national complete additionally declined during these years, however by about a third as a lot.
According to James’ self-reported “annual reviews,” Medicaid recoveries by her workplace went from $168 million in 2019, her first 12 months on the job, to simply $31 million in 2024.
It appears that fraud enforcement is the one factor about New York’s Medicaid program that’s shrinking reasonably than hovering.
Responding to a separate federal inquiry, the governor’s workplace lately declared that “New York has one of the largest MFCUs in the United States in terms of both staffing levels and total recoveries.”
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What that declare uncared for to point out, again, is that New York additionally has one of largest Medicaid budgets, second solely to California’s.
So the truth that New York additionally has the second-largest MFCU employees was no large shock.
And the truth that its gross recoveries ranked fifth — behind a lot smaller states corresponding to Indiana and Massachusetts — was not a lot to brag about.
What accounts for these seemingly poor statistics? One attainable clarification is the collection of labor-intensive lawsuits that James’ workplace has lodged in opposition to nursing properties.
These eye-opening instances accused operators of improperly siphoning away Medicaid {dollars} that ought to have been spent on affected person care, which allegedly resulted in disturbing ranges of neglect and abuse.
But they’ve but to set off a lot in the way in which of a crackdown from both the state Health Department or Legislature.
Meanwhile, the nursing-home push diverted time and personnel from different indicators of bother with Medicaid, such because the explosive growth of spending on home care.
That funding covers invaluable companies for disabled people who need it, nevertheless it’s additionally susceptible to fraud and abuse.
James may strive to dismiss the criticism of her document as politically motivated. If that’s the case, she ought to have little bother knocking down the arguments and defending herself from federal probers.
Both the federal authorities and her marketing campaign challenger are raising legitimate, substantive questions on a essential operate of the lawyer basic’s workplace.
Answers, please, AG James.
Bill Hammond is the senior fellow for health coverage on the Empire Center.
