Letitia James has been the New York Attorney General since 2019. Over seven years, her office has built one of the most active state-level nursing home enforcement programs in the country.
The total recovered from nursing home owners and operators is now over $70 million.
The most recent settlement closed in February 2026: $1.3 million from St. Margaret’s Center, a pediatric skilled nursing facility in Albany, after an investigation found years of neglect of children in the facility’s care. Staff failed twice to administer a resident’s anti-seizure medication. Children did not receive appropriate respiratory care. Supervision was inadequate. The facility had submitted false certifications of compliance with state and federal standards for at least five years.
The St. Margaret’s case is small compared to the Centers for Care settlement in 2024 ($45 million covering four facilities) or the Van Duyn Center case in Syracuse ($12 million in 2025). What makes it notable is that the pattern is identical.
The Case Files
Every AG nursing home settlement since 2023 has involved some combination of the same three failures.
| Case | Year | Amount | Core Findings |
|---|---|---|---|
| Centers for Care, LLC (four facilities) | 2024 | $45M | Financial fraud, resident neglect, $35M directed to resident care and staffing |
| Van Duyn Center for Rehabilitation (Syracuse) | 2025 | $12M | Neglect, financial fraud, $10M directed to resident care and staffing |
| Fulton Commons Care Center (East Meadow) | 2024 | $8.6M | Repeated financial fraud, resident mistreatment |
| Saratoga Center | 2023 | $7.1M | Understaffing, Medicaid fraud |
| St. Margaret’s Center (Albany) | 2026 | $1.3M | Pediatric nursing home, medication errors, respiratory care failures |
| Unlicensed operator | 2023 | $656K | Operating without a license, Medicaid fraud |
The total across these six cases alone is over $74 million. Additional smaller settlements bring the cumulative figure higher.
The Pattern
The AG press releases use slightly different language case to case, but the underlying fact pattern is consistent. Three elements appear in almost every investigation.
Financial fraud
Nursing home operators receive Medicaid reimbursement based on reported staffing levels, services provided, and occupancy. Operators who divert those dollars to related-party transactions, to owner compensation, or to off-the-books accounts leave the facility understaffed. Understaffing produces the next two elements.
Resident neglect
When a facility runs short on nurses and aides, residents fall more often. Medications get missed. Pressure ulcers develop. Wound care is skipped. Feeding assistance is rushed. The physical harm is direct and foreseeable.
Falsified certifications
State and federal nursing home regulation runs on self-reported compliance. Facilities certify they met staffing minimums, provided required care, and followed protocols. When those certifications are false, the penalty can be substantial (civil monetary penalties, False Claims Act exposure, exclusion from Medicaid), which is why most AG settlements include specific findings of false certification.
The St. Margaret’s case followed this pattern exactly. The investigation covered the period January 1, 2018 through December 31, 2023. Across five years, the facility certified compliance with state and federal nursing home laws while systematically failing to meet those standards.
The Private Side: South Shore Rehabilitation
The AG’s office handles cases that meet specific criteria: Medicaid fraud, patterns of misconduct, facilities where state enforcement authority is useful. Most individual cases of nursing home neglect do not go through the AG. They go through civil litigation.
In January 2026, a Nassau County Supreme Court Justice upheld a $5 million jury verdict against South Shore Rehabilitation and Nursing Center. The case involved a resident, Mr. Serrapica, who developed serious pressure ulcers due to inadequate monitoring and treatment. Expert medical testimony established that these failures contributed to his rapid decline and death.
The legal framework was , which gives nursing home residents (and their families in wrongful death cases) a private right of action for violations of their statutory rights. Unlike standard negligence, § 2801-d does not require plaintiffs to prove a specific breach of the standard of care in the way a medical malpractice case does. It is enough to show that the facility failed to comply with the statutory rights the resident was entitled to under state and federal nursing home law.
The South Shore case shows what is possible in private litigation. The $5 million verdict was for one resident whose family pursued a case and proved it at trial. There are thousands of similar fact patterns across New York nursing homes that never reach a courtroom.
What the AG Cases Tell Families
The AG investigations are diagnostic. They document, case by case, what happens when a nursing home is failing. The patterns are useful because they are consistent enough that families can use them as warning signs before harm occurs.
Staff who cannot answer basic questions
Residents in facilities with high turnover or chronic understaffing are cared for by aides who do not know their history. A family member asking “when was my mother last turned in bed” should get a specific answer. “I just came on shift” repeated across multiple visits is a signal.
Pressure ulcers
Stage 2 or higher pressure ulcers that develop or worsen after admission are one of the strongest indicators of inadequate care. Facilities are required to assess risk and implement prevention protocols on admission. When pressure ulcers appear, the facility’s prevention program has failed.
Medication errors
Missed doses, wrong doses, and wrong medications are documented in nearly every AG case. Families who observe confusion about what medications a resident is taking, or who find the resident has been off a scheduled medication for days, are seeing a direct sign of the staffing failure pattern.
Unexplained weight loss
A resident losing more than 5% of body weight in a month or 10% in six months is in nutritional decline. This often reflects staff who do not have time to provide feeding assistance to residents who need it.
Unexplained injuries
Bruises on parts of the body that would not result from a fall. Injuries at stages of healing inconsistent with facility-reported incident dates. Repeated falls without documented intervention changes.
The Legal Options in New York
When a family identifies nursing home neglect, several legal tools are available.
New York Public Health Law § 2801-d
Private right of action for violations of a resident’s rights under state or federal law. Available for personal injury and, through the wrongful death statute, for deaths caused by those violations. Damages include compensatory damages and, in some cases, attorney’s fees.
Negligence and medical malpractice
Standard tort claims for failures to meet the applicable standard of care. Three-year statute of limitations for negligence, 2.5 years for medical malpractice under , two years for wrongful death under .
Reporting to regulators
The NY Department of Health accepts complaints about nursing home care at 1-888-201-4563. The Attorney General’s Medicaid Fraud Control Unit investigates facilities where Medicaid fraud is suspected. Regulator action does not preclude civil litigation; they often run in parallel.
Federal False Claims Act
In cases involving Medicaid fraud, a relator (often a former employee) can file a qui tam action that allows the plaintiff to share in any federal recovery. These cases are complex and require specialized counsel.
The procedural deadlines matter. A Notice of Claim under (when the facility is publicly operated), the standard personal injury statute of limitations, and the wrongful death deadline can run in parallel, and missing any one of them narrows the case.
Why This Matters Now
The St. Margaret’s settlement is the AG’s first major nursing home action of 2026. The pattern in the case files suggests more are coming.
Two structural factors drive continued enforcement. First, the COVID-era enforcement moratoriums on certain nursing home compliance reviews have now expired, which has produced a backlog of cases the AG is working through. Second, New York implemented a minimum staffing law for nursing homes in 2023 that requires specific nurse-to-resident ratios. Facilities that fail to meet those ratios now have specific, documented compliance failures that make AG cases more straightforward to build.
For families with a loved one in a New York nursing home, the practical implications are two-fold. The regulatory environment is tighter than it has been in decades, which means documented problems are more likely to trigger state action than they would have been five years ago. And the civil litigation path, through § 2801-d, is as strong a private enforcement tool as exists in any state.
When the facility is failing, the law provides real tools for recovery. What is required is that families know what to watch for and act early enough to preserve evidence.
