AG targeting Medicaid fraud, elder abuse
Office will look for anomalies instead of waiting to receive complaints
Investigators with the New Mexico Attorney General’s Office said they will pore over Medicaid bills with an eye for suspicious activity in an attempt to find Medicaid fraud throughout the state.
Attorney General Hector Balderas on Wednesday announced plans to crack down on Medicaid fraud and elder abuse, saying both the state’s high number of elderly residents and babies born using Medicaid dollars are reasons to protect the integrity of the program. Medicaid is a health care program for people who can’t afford to buy their own.
“You have billions of dollars flowing through the system, and I’m concerned that you don’t have enough adequate checks and balances and accountability at the top,” he said.
He said the initiative will include reviewing Medicaid bills and data for suspicious practices, which could indicate fraud.
“We will be targeting and mining key, specific data that will be an important, game-changing effort to bring about a more accountable system for the most vulnerable population in New Mexico,” Balderas said at a news conference.
An awareness campaign that includes TV commercials is also part of the initiative.
About 40 percent of New Mexicans receive Medicaid coverage, and seven of 10 babies born in the state are born on Medicaid, Balderas said. He also said the state’s elderly population is expected to grow significantly in the next 10 years.
“New Mexico is one of the most needy and vulnerable states in the nation to Medicaid fraud,” he said. “We need every Medicaid dollar to go to necessary services.”
The office asked for and received a waiver from the federal government that allows investigators to look for fraud rather than wait for complaints, according to a news release.
Juliet Keene, the deputy director of the attorney general’s Medicare Fraud Control Division, said that before this initiative, the division would investigate for possible fraud after getting a complaint. From now on, the division will be reviewing Medicaid bills with an eye for anomalies to try to find fraud.
She said the office could take civil or criminal actions against possible suspects, depending on the circumstances.