HERNANDEZ UNVEILS FRAUD STRIKE TEAM AS MEDICAID COSTS SURGE AND FRAUD CONVICTIONS COLLAPSE

 

Joseph Hernandez, Republican candidate for New York State Comptroller, today demanded answers from Comptroller Thomas DiNapoli and Attorney General Letitia James after new data showed New York’s Medicaid spending more than doubled while criminal Medicaid fraud convictions collapsed.

 

Hernandez also announced a plan to create a dedicated Fraud Strike Team in the Comptroller’s Office.

 

Since 2010, New York’s Medicaid spending has grown 123%, from $51.8 billion to $115.6 billion in state fiscal year 2025. The current budget funds a $122.6 billion program.

 

Over the same period, criminal Medicaid fraud convictions fell from 102 in 2010 to 25 in 2025, a 75% decline. In the decade before 2020, the unit averaged 71 fraud convictions a year. Since 2020, it has averaged just 15.

 

“New York taxpayers now pay more than twice as much for Medicaid, and the number of people held criminally accountable for stealing from it has fallen off a cliff,” Hernandez said. “Where was the watchdog?”

 

This summer, the U.S. Department of Health and Human Services Office of Inspector General denied recertification of New York’s Medicaid Fraud Control Unit and suspended its federal funding. Federal officials said the unit had “repeatedly produced the lowest levels of criminal Medicaid fraud enforcement among large states,” despite receiving roughly $60 million in federal funding annually and employing more than 270 staff.

 

“The federal government just pulled the plug on the state’s fraud unit,” Hernandez said. “That is not a technicality. It is a verdict on how this state has policed its most expensive program.”

 

The Attorney General runs the Medicaid Fraud Control Unit, which is responsible for investigating and prosecuting Medicaid fraud. The Comptroller is the state’s chief fiscal officer and has held the office since 2007.

 

“One office is supposed to prosecute fraud. The other is supposed to sound the alarm on waste and abuse of taxpayer money,” Hernandez said. “Between them, New Yorkers got a program that costs more and a fraud unit that federal regulators say is failing. Tom DiNapoli owes voters an answer: what did your office do about it, and when?”

 

On day one, Hernandez will establish a dedicated Fraud Strike Team inside the Comptroller’s Office to audit, investigate, and refer suspected fraud. The team will target high-risk areas including home care agencies, non-emergency medical transportation, and the CDPAP fiscal intermediary transition.

 

The Strike Team will use claims analytics to flag suspicious billing patterns, refer suspected fraud directly to prosecutors and the Office of the Medicaid Inspector General, and publicly report every quarter on referrals and enforcement outcomes.

 

“Fraud doesn’t fix itself, and it won’t be fixed by an office that only shows up after the money is gone,” Hernandez said. “My Strike Team will find it, refer it, and publish the results every quarter, so no one can look the other way.”