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Federal and State Program Integrity in New Mexico

        New Mexico has adopted a series of statutes designed to protect the state’s public insurance programs from potential fraud and abuse.  The first of these is the Medicaid False Claims Act,1 which penalizes persons who present, or cause to be presented, any claim for payment under the Medicaid program that the person knows is false or fraudulent.  Cases may be brought by private individuals with knowledge of fraudulent claims; however, the state reserves the right to take over any case and determine whether or not the action should continue or be dismissed.2  In the event that an action is successful in court, the individual bringing the case is rewarded a percentage of the penalized amount between fifteen and twenty-five percent.3

        New Mexico also has a Medicaid Fraud Act that provides the state’s attorney general with the power and authority to investigate instances of fraud against the Medicaid program.4  The statute protects against such fraudulent activities as the giving of kickbacks and bribes in connection with the provision of treatments, services and goods reimbursed through Medicaid, and the presentation of claims for services either not provided or that are substantially inadequate.  Penalties for violating the Medicaid Fraud Act range from monetary fines to sentences for a fourth degree felony.5

        Finally, the state has a Fraud Against Taxpayers Act that also protects against the submission of false or fraudulent claims for payment under Medicaid.6  The act provides for penalties between $5,000 and $10,000 for each violation, as well as costs for damages and attorneys fees. 

 

Footnotes

  • 1. N.M.S.A. §27-14-4
  • 2. N.M.S.A. §27-14-8
  • 3. N.M.S.A. §27-14-9
  • 4. N.M.S.A. §30-44-7
  • 5. N.M.S.A. §30-44-8
  • 6. N.M.S.A. §44-9-3

 

Federal and State Program Integrity in New Mexico

Subtopic Statute/Regulation Description
Federal and State Program Integrity Civil action for false claims-N.M. Stat. Ann. § 27-14-7 If the Department determines an individual violated the Medicaid False Claims Act, the Department may bring a civil action against the individual....
Medicaid fraud; defined; investigation; penalties-N.M. Stat. Ann. § 30-44-7 Medicaid fraud includes paying, soliciting, offering, or receiving kickbacks or bribes, rebates of referral fees, and anything of value that is in...
Penalties for false claims Fraud Against Taxpayers Act – N.M. Stat. Ann. §44-9-3 Under the Fraud Against Taxpayers Act, a person may not:         Knowingly present to an employee, officer or...
Fraud and abuse provisions about Medicaid or Medicare: Anti-kickback laws Medicaid False Claims Act-N.M. Stat. Ann. §27-14-4 New Mexico has enacted a Medicaid False Claims Act to deter persons from causing the state to pay false Medicaid claims.  A person commits an...
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...
Fraud and abuse provisions about Medicaid or Medicare: False claims submitted to Medicaid or Medicare Medicaid False Claims Act-N.M. Stat. Ann. §27-14-4 New Mexico has enacted a Medicaid False Claims Act to deter persons from causing the state to pay false Medicaid claims.  A person commits an...
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...
Fraud and abuse provisions about Medicaid or Medicare: Laws prohibiting self-referrals Medicaid False Claims Act-N.M. Stat. Ann. §27-14-4 New Mexico has enacted a Medicaid False Claims Act to deter persons from causing the state to pay false Medicaid claims.  A person commits an...
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...