New Mexico Statutes 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 N.M. Stat. Ann..
Terms Used In New Mexico Statutes 27-11-16
- Allegation: something that someone says happened.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Fraud: Intentional deception resulting in injury to another.
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 N.M. Stat. Ann., 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.