2021 New Mexico Statutes
Chapter 27 - Public Assistance
Article 11 - Medicaid Providers
Section 27-11-16 - Credible allegation of fraud; judicial review; substantial evidence required.
A. A credible allegation of fraud determination by the department shall be deemed a final agency decision and may be appealed pursuant to Section 39-3-1.1 NMSA 1978.
B. A medicaid provider or subcontractor that is the subject of a referral to the attorney general for further investigation based on a credible allegation of fraud may seek judicial review, pursuant to Section 39-3-1.1 NMSA 1978, of the department's determination that the allegation of fraud is credible. The department shall show by substantial evidence that:
(1) it has followed its own procedures; and
(2) the evidence relied upon to make its credible allegation of fraud determination was relevant, credible and material to the issue of fraud.
C. In a proceeding for judicial review under this section, the reviewing court shall not consider evidence acquired by the department after making its credible allegation of fraud determination.
History: Laws 2019, ch. 215, § 14.
ANNOTATIONSEffective dates. — Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability. — Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
