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 unlawful act under the statute if he or she accomplishes one of the following:

•         Presents a claim for payment under the Medicaid program knowing that such claim is false or fraudulent;
•         Presents to the state a claim for payment under Medicaid 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.

A private individual may bring a False Claims action in the name of the state; however, the Department of Health has the exclusive responsibility for prosecuting the False Claims Act action, and may dismiss or settle the action without the individual’s input.  If the state elects not to proceed, the person bringing the original action may proceed with the case on his or her own.  If the Department proceeds with the action, then the individual who brought the original action may receive between fifteen and twenty-five percent of any award.