Medicaid Fraud Act – N.M. Stat. Ann. §30-44-7

New Mexico has a “Medicaid Fraud Act” that provides the attorney general and Department of Health with the power and authority to investigate Medicaid fraud.  Medicaid fraud is defined as paying, soliciting, offering or receiving:

•         a kickback or bribe in connection with the furnishing of treatment, services or goods for which payment is or may be made under the Medicaid program, including an offer
•         a rebate of a fee or charge made to a provider for referring a recipient to a provider
•         anything of value, knowing it to be in excess of amounts or rates authorized under Medicaid, as a precondition for providing treatment, care, services or goods as a requirement for continued provision of treatment or care

Additionally, Medicaid fraud can include presenting claims for services not provided, for services substantially inadequate compared to recognized standards, or for items that are altered, debased, mislabeled or outdated.

Anyone found guilty of fraud under the Medicaid Fraud Act will be either sentenced for a fourth degree felony or will be required to pay a fine, with the amount dependent on the level of fraud committed.