Letitia James Needs to Answer for the Medicaid Money That Went Nowhere

New York's AG Has Some Explaining to Do — And She Knows It

Letitia James has made a career out of demanding accountability from everyone she can reach. She's pursued Donald Trump through multiple courtrooms. She's gone after financial institutions, gun manufacturers, and just about anyone whose politics fall to her right. But when it comes to hundreds of millions in Medicaid irregularities that occurred during her tenure as the state's top law enforcement official, suddenly accountability is somebody else's problem.

The New York Post's reporting lays out a straightforward question: how did significant Medicaid billing irregularities go unaddressed while the AG's office was otherwise occupied with high-profile political prosecutions? New York's Medicaid program is the largest in the country. It exceeded $90 billion in annual expenditures in 2024, covering approximately 8.2 million New Yorkers. By consistent federal audit findings, it's also one of the most fraud-prone Medicaid programs in the nation.

I spent twelve years in uniform. I watched how accountability works in institutions where the stakes are high and the oversight is real. I also watched how it works in institutions where the stakes are political. The pattern is consistent: small violations with low-status perpetrators get prosecuted hard. Large institutional failures with politically connected actors get studied, commissioned, reviewed, and eventually forgotten.

Medicaid Fraud Harms the People James Claims to Represent

Every dollar that exits the Medicaid program through fraud is a dollar that doesn't reach a legitimate patient. This isn't an abstraction. New York Medicaid covers hundreds of thousands of veterans, disabled adults, elderly patients, and low-income families who have no alternative pathway to health coverage. When the program bleeds money through billing fraud, it bleeds coverage capacity.

When billing mills submit false claims — invoicing for services never rendered, enrolling patients in unnecessary treatments to run up the billing — the damage is compounded. Fraudulent providers crowd out legitimate ones. They corrupt the utilization data that the state uses to allocate resources and set reimbursement rates. They degrade the quality of care available to the most vulnerable patients in the system.

The Centers for Medicare and Medicaid Services estimated that improper payments in the national Medicaid program ran to $29.6 billion in fiscal year 2023. New York, with the country's largest state Medicaid program, contributes a disproportionate share of that figure. The Office of the Medicaid Inspector General is the primary fraud enforcement mechanism — but the AG's office has prosecutorial tools the Inspector General doesn't. James has those tools. She has chosen other priorities.

What are those priorities? Her office issued multiple press releases in single months related to gun-related prosecutions and consumer protection enforcement. Medicaid fraud case volume from the AG's office runs at a fraction of what the dollar amounts should demand.

The Double Standard Is Written in the Press Releases

An AG who campaigns on fighting powerful interests and protecting vulnerable New Yorkers carries a specific obligation regarding Medicaid fraud. The perpetrators aren't faceless multinationals. They're local providers — clinics and billing services operating in the same communities James says she represents. The victims are exactly the people her political brand says she's for.

When an elected official's enforcement priorities consistently align with their political profile — aggressive on gun dealers and big banks, quiet on billing fraud in healthcare networks — that's selective prosecution. Not necessarily corrupt, but selectively prioritized in ways that happen to serve political interests rather than the distribution of actual harm.

I'm not accusing James of corruption. I'm accusing her of having a political brand that depends on accountability rhetoric while her own enforcement record has a significant gap in it. That gap involves one of the most expensive fraud environments in state government. It involves money that should have reached sick people and didn't. It deserves the same aggressive scrutiny she's applied to everyone she's investigated.

The asymmetry isn't subtle. James pursued Trump's financial records with extraordinary persistence over multiple years. She has not applied comparable persistence to Medicaid fraud in a $90 billion program that produces documented nine-figure improper payment estimates annually.

Accountability Goes Both Ways, Even for Attorneys General

James is clearly building toward something larger than the AG's office. Every press conference, every prosecution announcement, every high-profile case is building a political brand. That brand depends on the public believing she applies accountability without fear or favor, regardless of whose interests are affected.

The Medicaid numbers undercut that brand. Not fatally. Not immediately. But questions don't disappear just because the person being questioned prefers not to answer them. How much Medicaid fraud occurred in New York during her tenure? What enforcement actions did her office take or explicitly decline to take? What was the basis for those resource allocation decisions?

She demands answers to those kinds of questions from everyone she investigates. Voters and taxpayers have the right to demand the same answers from her. If the answers are good, give them. If her office was genuinely resource-constrained and made difficult triage decisions, explain that. The longer the silence lasts, the worse the reasonable inference gets.

Accountability is the brand. Honor the brand.