New Mexico Healthcare Fraud/Medicare Fraud Enforcement

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In New Mexico, major healthcare fraud is civilly and criminally prosecuted by the District of New Mexico United States Attorney’s Office and the State’s own Medicaid Fraud Control Unit.

The federal government often accomplishes this task with the assistance of the New Mexico Medicaid Fraud Control Unit (MFCU). The MFCU takes the responsibility of stopping fraud very seriously and is often assisted in its efforts by the bravery and actions of whistleblowers.

Modeled after the federal False Claims Act, the New Mexico False Claims Act permits private citizens to bring qui tam actions on behalf of the State of New Mexico to recover treble damages and civil penalties. N.M. Stat. Ann §§ 27-14-1 et seq.

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the New Mexico qui tam statute as part of an action under the federal False Claims Act. We do so under the Court’s pendent jurisdiction.

The liability provisions of the New Mexico False Claims Act, N.M. Stat. Ann §§ 27-14-1, Section 4, provide that a person shall be liable if the person:

A. 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;

B. 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;

C. 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;

D. conspires to defraud the state by getting a claim allowed or paid under the Medicaid program knowing that such claim is false or fraudulent;