MFEA News releases

Get the latest news about the activities of the New Mexico Attorney General’s Office.

Santa Fe Husband & Wife Must Repay Medicaid System 59K

posted Apr 24, 2012, 10:38 AM by Zack Freeman

Santa Fe Husband & Wife Must Repay Medicaid System 59K...Judge Orders Offenders To Serve Probation Friday, February 17, 2012

 


(SANTA FE)---New Mexico Attorney General Gary King's Medicaid Fraud and Elder Abuse Division reports today that Catherine and Joseph Hernandez of Santa Fe have been sentenced to repay the Medicaid system $59,000 and serve probation.

Santa Fe's District Court Judge Michael Vigil instructed Catherine Hernandez to pay back $52,000 to the Medicaid system and serve five years probation.  Joseph Hernandez will pay back $7,000 and serve three years probation.  

Both were found guilty by a Santa Fe Jury in January of Medicaid Fraud and Falsification of Document charges related to crimes committed between April 2006 and February 2010.

The Medicaid Fraud and Elder Abuse Division of the New Mexico Attorney General's Office is the federally mandated Medicaid Fraud Control Unit for the State. It enforces the Medicaid Fraud Act, and the Resident Abuse and Neglect Act. The Division investigates and prosecutes Medicaid providers who commit fraud and/or resident abuse, neglect and exploitation in long-term care facilities.


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Santa Fe Husband and Wife Found Guilty of Medicaid Fraud

posted Apr 24, 2012, 10:36 AM by Zack Freeman

Santa Fe Husband and Wife Found Guilty of Medicaid Fraud...AG's Medicaid Fraud and Elder Abuse Division Successfully Prosecutes

Tuesday, January 17, 2012

(SANTA FE)---New Mexico Attorney General Gary King's Medicaid Fraud and Elder Abuse Division reports today Catherine and Joseph Hernandez of Santa Fe have been found guilty by a Santa Fe County jury of Medicaid Fraud and Falsification of Documents.

Catherine Hernandez has been found guilty of Medicaid Fraud, counts 1,2 and 3 and Falsification of Documents, counts 4, 5 and 6. She could face 9 years in prison and repayment up to $55,000.

Joseph Hernandez has been found guilty of one count each, Medicaid Fraud and Falsification of Documents. He faces a possible prison sentence of up to three years and potential repayment up to $7,000.

The crimes committed occurred between April 2006 and February 2010.

Sentencing will take place on Thursday, February 16, 2012 at 4:00 PM in District Court Judge Michael Vigil's courtroom.  The Honorable Judge Vigil did not require a pre-sentencing report though he instructed both prosecution and defense attorneys to be prepared to argue restitution at the hearing next month.

The Medicaid Fraud and Elder Abuse Division of the New Mexico Attorney General's Office is the federally mandated Medicaid Fraud Control Unit for the State. It enforces the Medicaid Fraud Act, and the Resident Abuse and Neglect Act. The Division investigates and prosecutes Medicaid providers who commit fraud and/or resident abuse, neglect and exploitation in long-term care facilities.


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AG's Office Wins Major Medicaid Fraud Cases

posted Apr 24, 2012, 10:34 AM by Zack Freeman   [ updated Apr 24, 2012, 10:34 AM ]

AG's Office Wins Major Medicaid Fraud Cases...Las Cruces Corporation & 3 Individuals Found Guilty Tuesday, November 15, 2011 

 

(LAS CRUCES)---Prosecutors from Attorney General Gary King's office were successful obtaining guilty verdicts against a Las Cruces Medicaid provider and four individuals on Medicaid Fraud and other charges.

Counseling and Mediation, LLC, and Arcilia Holguin, the owner of Counseling and Mediation, were indicted in April 2010 on various counts of Medicaid Fraud, Fraud, and other related charges. Testimony at trial showed that Ms. Holguin and her employees were failing to provide the services they had contracted with Medicaid to provide, altering documentation to make it look like they were providing an appropriate service, and billing outrageous amounts of time for providing certain services.

Arcilia Holguin and Counseling and Mediation Services, LLC, were tried by a jury the first week of November, and were each found guilty on all the counts. Holguin was found guilty of Medicaid Fraud - Falsification of Documents (a fourth degree felony), Fraud over $20,000 (a second degree felony offense), Medicaid Fraud - Excessive Claims (a fourth degree felony offense), Medicaid Fraud - Substantially Inadequate Treatment over $20,000 (a second degree felony offense), and Fraud (over $20,000). Counseling and Mediation, LLC, was found guilty on similar charges. AG prosecutors showed that Ms. Holguin and Counseling and Mediation, LLC, overbilled Medicaid in the amount of $218,132.38. The corporation is also potentially subject to $500,000 worth of fines for the felony convictions, based on the Medicaid Fraud statute Section 30-44-7 (G). Holguin has 36 years exposure to jail time and the AG's office will recommend restitution, although sentencing has not yet been scheduled.

"It is not often that a corporation is found guilty in Medicaid fraud cases so this is a great win for the people of New Mexico and hopefully serves as a warning for other providers," says AG Gary King. "I congratulate our Medicaid Fraud & Elder Abuse Division staff for their perseverance and ability to take these cases all the way."

The other defendants, Lazaro Molina and Juana Barba, of El Paso, TX., were found guilty earlier this year on Medicaid Fraud and related charges. Penalties included incarceration, probation, and restitution.

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...State Receives $622K in Agreement with En Su Casa Personal Care

posted Apr 24, 2012, 10:31 AM by Zack Freeman

AG Brokers Settlement with Medicaid Services Provider...State Receives $622K in Agreement with En Su Casa Personal Care

Tuesday, May 31, 2011

(SANTA FE)---Attorney General Gary King's Medicaid Fraud & Elder Abuse Division announces an agreement with THI of New Mexico at En Su Casa, LLC, to reimburse the State and improve caregiver screening.

The MFEAD received complaints by the Aging and Long Term Services Department (ALTSD), claiming En Su Casa was (1) utilizing unqualified, untrained, and unscreened caregivers as a part of its Personal Care Option services program, (2) that the facility had not conducted required nationwide criminal history screenings, verified first aid/CPR training, and TB testing, and (3) that required monthly supervisory visits were not being done.  In addition to an audit, MFEAD conducted an investigation into the falsification of certain TB testing documentation and found it to have been falsified.

En Su Casa denies the allegations in their entirety; however, since the MFEAD audit, En Su Casa has instituted new policies, conducted staff training, regularly audits for compliance with the PCO regulations, and believes it is currently in substantial compliance with regulations with respect to current staff. In the interest of avoiding litigation, and without conceding the validity of accuracy of the allegations, En Su Casa seeks to resolve and settle these matters upon the terms and conditions set forth in the settlement agreement.
En Su Casa shall pay the State of New Mexico a total amount of $622,709.20 that involve two separate cases.

[The full settlement agreement is attached]


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Judge Orders Restitution in Medicaid Fraud Case

posted Apr 24, 2012, 10:28 AM by Zack Freeman

Judge Orders Restitution in Medicaid Fraud Case...AG's Office Ramps Up Indictments & Convictions

Tuesday, April 26, 2011   

(ALBUQUERQUE)---Attorney General Gary King today announced sentencing for an Albuquerque woman convicted of Medicaid fraud that requires her to repay every penny she stole from the program.

Antoinette Lopez, 44, was sentenced today following her guilty plea last week to one count of Medicaid Fraud, a fourth degree felony. The guilty plea was entered before Second Judicial District Judge Ross Sanchez, who also sentenced Lopez to eighteen months of supervised probation. The defendant made full restitution, totaling $6361.36, at the time she entered her guilty plea. Additionally, Lopez will be subject to an administrative exclusion prohibiting her future employment in health care facilities that participate in federally-funded health care programs.

The case involved Lopez’s submission of false timesheets for Medicaid and state-funded respite services, claiming hours she had not actually worked, between March, 2009, and March, 2010. The prosecutor for the AGO was Assistant Attorney General David Hughes. Last week, another Albuquerque woman was indicted for Medicaid fraud.

The Medicaid Fraud and Elder Abuse Division of the Attorney General's Office is certified by the federal government to investigate and prosecute the abuse, neglect and exploitation of Medicaid recipients as mandated by federal and state law. Last year the division was credited with collections of more than $1.64 million that were returned to the New Mexico Medicaid program. The AGO expects to increase prosecutions this year.

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Albuquerque Woman Indicted for Medicaid Fraud

posted Mar 23, 2012, 12:49 PM by Zack Freeman

Albuquerque Woman Indicted for Medicaid Fraud...Attorney General's Office Investigation Leads to Charges
Thursday, April 21, 2011



(ALBUQUERQUE)---Attorney General Gary King's office says following its investigation, a Bernalillo County grand jury has indicted 33-year-old Angela Lujan on one count of Medicaid Fraud and one count of Falsification of Documents. Both charges are fourth degree felonies.

AG King's Medicaid Fraud & Elder Abuse Division will prosecute the case against defendant Lujan as part of its continuing work to protect the health care program. Medicaid Fraud is an offense that compromises the integrity of public benefits programs designed to provide care for vulnerable New Mexicans.

The indictment alleges the defendant, between December 2007, and April 2009, provided Medicaid-funded personal care option in-home services which were inadequate, or submitted false claims for provision of these services. Count II alleges Falsification of Documents during the same time period.

The defendant could face imprisonment of up to eighteen (18) months each on the Medicaid Fraud count and the Falsification of Documents count.

The case has been assigned to Second Judicial District Judge Pat Murdoch.  An arraignment date has not yet been scheduled.

Women Sentenced for Medicaid Fraud

posted Mar 23, 2012, 10:17 AM by Zack Freeman

Women Sentenced for Medicaid Fraud...Valencia County Pair Conned State for $96K
Monday, December 27, 2010

(ALBUQUERQUE)---Mollie Stacey and Deborah Cronn claimed to be each other's caregiver in order to bilk the Medicaid system for more than $96,000; now the women face prison, probation, and restitution.
Prosecuted by Attorney General Gary King's Medicaid Fraud & Elder Abuse Division, the defendants were each sentenced last week by Valencia County District Judge William A. Sanchez following convictions of both women on one count of Medicaid Fraud over $2500, one count of Falsification of Documents, and one count of Conspiracy to Commit Medicaid Fraud.
Mollie Stacey was sentenced to three years imprisonment, while Deborah Cronn was placed on supervised probation for three years and ordered to make restitution. The Medicaid Fraud count is a third degree felony carrying a potential prison term of three years and a $5,000 fine, while the other two counts are fourth degree felonies, each carrying a potential prison term of 18 months and a $5000.00 fine. As a further result of these convictions both women are excluded from employment in any facility participating in a federally-funded healthcare program.
Between March 1, 2005, and October 31, 2007, Stacey and Cronn each received Medicaid and falsely claimed to be disabled to the point of needing additional in-home services from the Medicaid Personal Care Option Program. By submitting requests through different agencies that provide these services and then submitting applications to be each other’s caregiver, the women were each able to receive paychecks based on their submission of timesheets. These false submissions resulted in the payment by the New Mexico Medicaid Program in the amount of $96,264.80.

NM Gets Back $194K for State Medicaid Program

posted Mar 23, 2012, 9:50 AM by Zack Freeman

NM Gets Back $194K for State Medicaid Program...Adulterated Drug Settlement Nets $750 Million Nationwide
Thursday, October 28, 2010

(ALBUQUERQUE)---Attorney General Gary King's Medicaid Fraud and Elder Abuse Division reports GlaxoSmithKline (GSK) will reimburse $194,443.53 to New Mexico's Medicaid program to settle allegations of selling adulterated Paxil CR,Avandamet, Kytril, and Bactroban.

The National Association of Medicaid Fraud Control Units joined the federal government to reach an agreement with pharmaceutical manufacturer GSK to pay the states and the federal government $600 million in civil damages and penalties for Medicaid and other federally-funded health care programs.
 
GSK subsidiary, SB Pharmaco of Puerto Rico, where the drugs were manufactured, has agreed to plead guilty to a felony violation of the U.S. Food, Drug, and Cosmetic Act and will pay $150 million in criminal fines and forfeitures.

The four drugs whose strength, purity and/or quality fell below the standards required by the FDA and their intended purposes are listed below:

Paxil CR: A controlled-release antidepressant that included split tablets, causing recipients to receive either product with no active ingredient and/or product with only the active ingredient layer and no controlled release mechanism;

Avandamet: A diabetes medication with tablets containing higher or lower amounts of the active ingredient than specified;

Kytril: An anti-nausea drug labeled as sterile but with some vials containing impurities; and,

Bactroban: Antibiotic ointments and creams that, in some packages, were contaminated with microorganisms.

GSK has agreed to the terms of a Corporate Integrity Agreementwith the Department of Health and Human Services Office of the Inspector General which will require scrutiny of GSK’s future manufacturing practices.  The investigation that led to the current settlement grew out of a false claims action filed in 2004 in U.S. District Court in Massachusetts.

Another Medicaid Fraud Case Win for AG

posted Mar 23, 2012, 9:43 AM by Zack Freeman   [ updated Mar 23, 2012, 9:46 AM ]

Another Medicaid Fraud Case Win for AG...Caregiver Pleads Guilty to Cheating the State
Thursday, October 07, 2010 



(ALBUQUERQUE)---AG Gary King's Medicaid Fraud and Elder Abuse Division (MFEAD) reports 26-year-old Robert Lopez pled guilty to cheating the Medicaid system by filing false claims for respite services.

Lopez, of Albuquerque, admitted to one count of Medicaid Fraudand one count of Falsification of Documents in front of Bernaillo County District Judge Robert Schwartz on Wednesday. He submitted falsified timesheets for Medicaid funded respite services between January 1, 2008 and June 30, 2008, claiming 180 hours he did not work.

The defendant is now barred from employment by any agency or facility that participates in, or is funded by, any federally-funded healthcare program and has paid back all monies wrongly received. Each count is a forth-degree felony carrying a possibility of 18-months incarceration. Lopez will be sentenced by Judge Schwartz at a later date.

The AGO Medicaid Fraud and Elder Abuse Division is the federally mandated Medicaid Fraud Control Unit for New Mexico and enforces the Medicaid Fraud Act and the Resident Abuse and Neglect Act.  The MFEAD staff is comprised of attorneys, CPA forensic auditors, law enforcement officers, and nurse medical investigators.

Valencia County Pair Plead Guilty to Medicaid Fraud

posted Mar 23, 2012, 9:40 AM by Zack Freeman

Valencia County Pair Plead Guilty to Medicaid Fraud...AG's Office Says Women Bilked System for Big Bucks
Thursday, September 30, 2010

(ALBUQUERQUE)---New Mexico Attorney General Gary King's office says two Los Lunas women admit to cheating the state Medicaid program out of $96,264.80 by claiming to be each other's caregivers.

The AG's Medicaid Fraud & Elder Abuse Division prosecuted the case against 61-year-old Mollie Stacey and 55-year-old Deborah Cronn in Valencia County District Court.  Stacey and Cronn each entered guilty pleas to one count of Medicaid Fraud over $2500, one count of Falsification of Documents, and one count of Conspiracy to Commit Medicaid Fraud. The Medicaid Fraud count is a third degree felony carrying a potential prison term of three years and a $5,000 fine, while the other two counts are fourth degree felonies, each carrying a potential prison term of 18 months and a $5000.00 fine. Stacey entered her plea on 9-21-10 and Cronn entered her plea on 9-27-10.

Between March 1, 2005, and October 31, 2007, Stacey and Cronn each received Medicaid and falsely claimed to be disabled to the point of needing additional in-home services from the Medicaid Personal Care Option Program. By submitting requests through different agencies that provide these services and then submitting applications to be each other’s caregiver, the women were each able to receive paychecks based on their submission of timesheets. These false submissions resulted in the payment by the New Mexico Medicaid Program in the amount of $96,264.80.

Sentencing of both defendants will occur at a future date before Judge William Sanchez.

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