New Mexico’s whistleblowers laws allow whistleblowers to report fraud and receive 15-30% of the proceeds in a successful qui tam action
New Mexico has two whistleblower statutes: 1.) the Medicaid False Claims Act combats fraudulent claims presented to the State’s Medicaid program, and 2.) the Fraud Against Taxpayers Act combats fraudulent claims presented to the State or its political subdivisions.
New Mexico Medicaid False Claims Act
A private person can bring a civil action for a violation of the New Mexico Medicaid False Claims Act on behalf the state. This action is known as a qui tam action. In the event of a successful action, the whistleblower is entitled to 15% – 30% of the proceeds of the action or settlement; plus an amount for reasonable expenses, attorney fees and costs. Under the statute, whistleblowers are protected against retaliation for reporting fraud and engaging in protected activities.
The State’s Medicaid False Claims Act—N.M. Stat. Ann. 27-14-1 to 27-14-15—imposes liability on any person who:
- 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;
- 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;
- 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.
Violators are liable to the State for three times the amount of damages that the state sustains as a result of the acts of the person.
Fraud Against Taxpayers Act
A person can bring a civil action for a violation of the Fraud Against Taxpayers Act on behalf of the state or political subdivision. In the event of a successful action, the whistleblower is entitled to 15-30% of the proceeds of the action or settlement, plus an amount for reasonable case expenses and attorney fees. Under the statute, whistleblowers are protected against retaliation for reporting fraud and engaging in protected activities.
Unlike the State’s Medicaid False Claims Act, the New Mexico Fraud Against Taxpayers Act imposes a civil penalty of $5,000 – $10,000 for each violation on the violators. This is in addition to three times the amount of damages sustained by the state or political subdivision because of the violation.
The Fraud Against Taxpayers Act—N.M. Stat. Ann. 44-9-1 to 44-9-14—imposes liability on persons who:
- knowingly present, or cause to be presented, to an employee, officer or agent of the state or a political subdivision or to a contractor, grantee or other recipient of state or political subdivision funds a false or fraudulent claim for payment or approval;
- knowingly make or use, or cause to be made or used, a false, misleading or fraudulent record or statement to obtain or support the approval of or the payment on a false or fraudulent claim;
- conspire to defraud the state or a political subdivision by obtaining approval or payment on a false or fraudulent claim;
- conspire to make, use or cause to be made or used, a false, misleading or fraudulent record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state or a political subdivision;
- when in possession, custody or control of property or money used or to be used by the state or a political subdivision, knowingly deliver or cause to be delivered less property or money than the amount indicated on a certificate or receipt;
- when authorized to make or deliver a document certifying receipt of property used or to be used by the state or a political subdivision, knowingly make or deliver a receipt that falsely represents a material characteristic of the property;
- knowingly buy, or receive as a pledge of an obligation or debt, public property from any person that may not lawfully sell or pledge the property;
- knowingly make or use, or cause to be made or used, a false, misleading or fraudulent record or statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the state or a political subdivision; or
- as a beneficiary of an inadvertent submission of a false claim and having subsequently discovered the falsity of the claim, fail to disclose the false claim to the state or political subdivision within a reasonable time after discovery.
