Do You Have Knowledge of New Mexico Medicaid Fraud?
Taxpayer funded health care programs like New Mexico Medicaid are in place to provide quality, affordable health care services to low-income families and individuals who could otherwise not afford care. When dishonest, corrupt health care professionals take advantage of New Mexico Medicaid funds for their own profit, New Mexico’s taxpayers pay the price through resulting tax increases and rising health care costs.
Because whistleblowers’ knowledge of New Mexico Medicaid fraud is crucial to putting a stop to fraud, the New Mexico Medicare False Claims Act awards whistleblowers with 10% to 30% of the total government recovery. New Mexico health care professionals who provide services to New Mexico Medicaid beneficiaries are in a key position to detect and report fraud. Help put a stop to New Mexico Medicaid fraud. If you have information regarding Medicaid Fraud, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.
Review the Various Types of Medicaid Fraud
Reporting New Mexico Medicaid Fraud
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What New Mexico Laws Apply to Reporting Medicaid Fraud?
The New Mexico Medicaid False Claims Act (MFCA), N.M. Stat. Ann. §§27-14-1 et seq., allows private citizens with information on suspected New Mexico Medicaid fraud to file a claim on behalf of the state and collect a share of any government recovery.
Under the MFCA, a person commits an unlawful act and shall be liable to the state for three times the amount of damages that the state sustains as a result of the act if the person:
- presents, or causes to be presented, to the state a claim for payment under the Medicaid program knowing that such claim is false or fraudulent;
- presents, or causes to be presented, to the state a claim for payment under the Medicaid program knowing that the person receiving a Medicaid benefit or payment is not authorized or is not eligible for a benefit under the Medicaid program;
- makes, uses or causes to be made or used a record or statement to obtain a false or fraudulent claim under the Medicaid program paid for or approved by the state knowing such record or statement is false;
- conspires to defraud the state by getting a claim allowed or paid under the Medicaid program knowing that such claim is false or fraudulent;
- makes, uses or causes to be made or used a record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state, relative to the Medicaid program, knowing that such record or statement is false;
- knowingly applies for and receives a benefit or payment on behalf of another person, except pursuant to a lawful assignment of benefits, under the Medicaid program and converts that benefit or payment to his own personal use;
- knowingly makes a false statement or misrepresentation of material fact concerning the conditions or operation of a health care facility in order that the facility may qualify for certification or recertification required by the Medicaid program; or
- knowingly makes a claim under the Medicaid program for a service or product that was not provided.
Similarly, the New Mexico Fraud Against Taxpayers Act (FATA), N.M. Stat. Ann. §§44-9-1 et seq. allows whistleblowers to file a claim on behalf of the government against those whose conduct defrauds the government of taxpayer dollars.
A person is in violation of the FATA if they:
- knowingly present, or cause to be presented a false or fraudulent claim for payment or approval;
- knowingly make or use, or cause to be made or used, a false record or statement to obtain approval or payment on a false or fraudulent claim;
- conspire to defraud the state by obtaining approval or payment on a false claim;
- when in possession, custody or control of property or money used or to be used by the state, knowingly deliver or cause to be delivered less property or money than the amount indicated on a certificate or receipt;
- when authorized to make or deliver a document certifying receipt of property used or to be used by the state, knowingly make or deliver a receipt that falsely represents the property used or to be used;
- knowingly buy, or receive as a pledge of an obligation or debt, public property from any person that may not lawfully sell or pledge the property;
- knowingly make or use, or cause to be made or used, a false record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state; or
- as a beneficiary of an inadvertent submission of a false claim and having subsequently discovered the falsity of the claim, fail to disclose the false claim to the state agency within a reasonable time after discovery.
Proof of specific intent to defraud is not required for a violation of the FATA.
A person who violates the FATA shall be liable for three times the amount of damages sustained by a state agency because of the violation, a civil penalty of between $5,000 and $10,000 for each violation, the costs of a civil action brought to recover damages or penalties and reasonable attorney fees, including fees for state agency counsel.
New Mexico whistleblower laws provide rights and protections to individuals who step forward and In 2015, New Mexico’s Medicaid Fraud Control Unit investigations resulted in 7 criminal convictions and 12 civil settlements and judgements, recovering over $350,000 in stolen taxpayer dollars for the state of New Mexico. Health care professionals with inside information on New Mexico Medicaid fraud are an invaluable resource when it comes to recovering stolen dollars and stopping fraud, waste and abuse. If you feel you have knowledge of New Mexico Medicaid fraud, don’t hesitate to contact the Medicaid Fraud Hotline.
Does New Mexico Law Provide Protection For Those Reporting Medicaid Fraud?
Under the New Mexico Medicaid False Claims Act (MFCA), N.M. Stat. Ann. §§27-14-1 et seq., any employee who is discharged, demoted, suspended, threatened, harassed or otherwise discriminated against by the employer because of lawful acts done by the employee on behalf of the employee or others in disclosing information to the department or in furthering a false claims action pursuant to the Medicaid False Claims Act, including investigation for, initiation of, testimony for or assistance in an action filed or to be filed pursuant to that act, shall be entitled to all relief necessary to make the employee whole.
Likewise, under the New Mexico Fraud Against Taxpayers Act (FATA), N.M. Stat. Ann. §§44-9-1 et seq., an employer shall not discharge, demote, suspend, threaten, harass, deny promotion to or in any other manner discriminate against an employee because of the lawful acts in disclosing information to a government or law enforcement agency or in furthering a fraud against taxpayers action, including investigating, initiating, testifying or assisting in an action pursuant to the Fraud Against Taxpayers Act.
Whistleblowers Are Entitled To Remedies When Subjected to Employer Retaliation
Under both the MFCA and FATA, whistleblowers who experience workplace retaliation are entitled to all damages essential to “make the employee whole.” These remedies include:
- Job reinstatement with the same seniority status
- Two times the amount of any back pay owed the employee
- Interest on any back pay owed the employee
- Compensation for any special damages sustained, including costs and expenses of litigation and reasonable attorneys’ fees.
What Cash Awards Are Available for Reporting New Mexico Medicaid Fraud?
Under both the New Mexico Medicaid False Claims Act (MFCA), N.M. Stat. Ann. §§27-14-1 et seq., and the New Mexico Fraud Against Taxpayers Act (FATA), N.M. Stat. Ann. §§44-9-1 et seq., the whistleblower who filed the initial complaint is entitled to the following amounts if the state prevails in the action:
- If the state chose to intervene in the action, the whistleblower is entitled to between 15% and 25% of the proceeds of the action or settlement, plus reasonable attorneys’ fees and an amount to cover the expenses and costs of bringing the action.
- If the state opts not to intervene in the action, the whistleblower is entitled to between 25% and 30% of the proceeds of the action or settlement, plus reasonable attorneys’ fees and an amount to cover the expenses and costs of bringing the action.
Final award amounts are calculated based upon the significance of the information provided by the whistleblower and the extent of the role the whistleblower plays in the investigation and advancing the case to litigation.
New Mexico whistleblower laws provide protections to individuals who step forward and report misconduct. In addition, the government pays a significant cash award, often in the hundreds of thousands to millions of dollars, for reporting New Mexico Medicaid fraud when an investigations leads to government recovery. If you feel you have knowledge of New Mexico Medicaid fraud, don’t wait to contact the Medicaid Fraud Hotline.
What is the New Mexico Statute of Limitations on Reporting Medicaid Fraud?
Under both the New Mexico Medicaid False Claims Act (MFCA), N.M. Stat. Ann. §§27-14-1 et seq., and the New Mexico Fraud Against Taxpayers Act (FATA), N.M. Stat. Ann. §§44-9-1 et seq., a whistleblower lawsuit must be brought:
- within 3 years after the date when facts material to the right of action are discovered or reasonably should have been discovered, and
- no longer than 10 years after the date on which the violation is committed.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have information regarding Medicaid Fraud in the State of New Mexico, contact the Medicaid Fraud Hotline or fill out the online report form. Time is of the essence! You must be the FIRST to report to secure your role as whistleblower and be eligible for a cash award. Statutes of limitations apply.
Over $1 Million in Cash Awards for Tips Leading to Government Recovery