New Mexico Statutes
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.
Effective 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.

Structure New Mexico Statutes