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N.M. Fraud-o-Mania Alleged

N.M. Fraud-o-Mania Alleged

Critics of Martinez have charged the shift to out-of-state providers crippled New Mexico's system of health health delivery of services.

Updated to correct the date the Martinez administration took office and add detail.


A newly unsealed federal whistleblower lawsuit accuses vendors for the State of New Mexico of defrauding taxpayers of $88 million in funds spent on behavioral health programs.

The lawsuit names as defendants four related Minnesota companies and alleges billings for services not rendered, plus retaliation against the person who tried to bring the fraud allegations to the attention of people in charge.

The lawsuit was brought by Karen Clark, who worked for the Special Investigations Unit of Optum Health Behavioral Solutions, one of the companies named in the lawsuit.

The lawsuit, filed in New Mexico U.S. District Court back in 2013 and only unsealed last month, alleges the vendors’ internal auditors ignored warnings that billings were false and continued to authorize payment for behavioral services not performed for an alphabet soup of state agencies.

The transfer of New Mexico’s behavioral health services by the Martinez administration from in-state providers to out-of-state entities upon her swearing-in on Jan. 1, 2011,  been a major point of contention between her administration and the Democratically-controlled Legislature.

Critics of Martinez have charged that Martinez’s politically motivated shift to hundreds of millions of dollars to out-of-state providers crippled New Mexico’s system of health health delivery of federally funded services.

The lawsuit names the following companies as defendants: United Healthcare Group; United Healthcare Insurance Co.; United Behavioral Health Inc.; and Optum Health New Mexico. All are related companies.The allegations in the lawsuit date from 2009, which predates the Martinez administration, but they continue through the spring of 2012.  The Martinez administration took office on Jan. 1, 2011.

It also names nine New Mexico behavioral health subcontractors with offices in Albuquerque, Las Cruces, Farmington, Roswell, Artesia, Portales, Carlsbad, Grants, and Los Ranchos.It alleges they knowingly overbilled for services and billed for services they did not deliver.

The list of state agencies allegedly defrauded spans much of state government. According to the lawsuit, the alleged fraud was committed against:

The Department of Health; the Department of Human Services; the Children Youth and Families Department; the Aging and Long Term Services Department; the Department of Finance and Administration; the Mortgage Finance Authority; the Public Education Department; the Department of Transportation; the New Mexico Corrections Department; the Division of Vocational Rehabilitation; the Department of Labor; the Health Planning Commission; the Developmental Disabilities Planning Commission; the Health Policy Planning Commission; the Developmental Disabilities Planning Council; the Governor’s Council on Disabilities; the Indian Affairs Department; the governor’s senior health policy advsier; and the Administrative Office of the Courts.

The lawsuit alleges “falsified records, provided by unlicensed providers, not medically necessary, billed using inapplicable and improper billing codes for a period from 2009 and onward.”

The lawsuit was kept under wraps for three years to allow the U.S. government and the Office of the New Mexico Attorney General time to decide whether to join it. Both declined to join.

Spokesmen for Gov. Martinez and the Department of Health did not respond to requests for comment Thursday night before this story was posted.

Under the Civil War-era Qui Tam law, if the government declines to participate, the plaintiff can elect to proceed at his or her own cost, and reap a share of the receovery of any alleged ill-gotten gains. The law was passed during Abraham Lincoln’s term in office as a way to curb Civil War profiteers trying to defraud the federal government during war-time provisioning.

Read the lawsuit for yourself here.

Dan Vukelich is editor of ABQ Free Press. Reach him at editor@freeabq.com.



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Dan Vukelich is a writer and former editor of ABQ Free Press.

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Ashley Kurtz is a freelance theater critic.

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