Section 27-11-15 – Disposition of recovered medicaid funds.
A. Overpayments collected pursuant to the Medicaid Provider and Managed Care Act on behalf of the state shall be remitted to the department for deposit in the general fund to be used for the state’s medicaid program. B. The department shall not enter into a contract to pay any portion of funds recovered by the […]
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 […]
Section 27-11-17 – Award of costs, fees and interest.
A. If a medicaid provider or subcontractor is the prevailing party in any expedited adjudicatory or court proceeding brought by the medicaid provider or subcontractor pursuant to the Medicaid Provider and Managed Care Act on or after January 1, 2020 in connection with a preliminary or final determination of overpayment or a determination of credible […]
Section 27-11-18 – Applicability of Administrative Procedures Act.
A. The department shall be subject to Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 1978 for expedited adjudicatory proceedings as provided by the Medicaid Provider and Managed Care Act. B. Sections 12-8-2, 12-8-10 through 12-8-13, 12-8-15 and 12-8-16 NMSA 1978 apply to Sections 5 [22-11-7 NMSA 1978], 7 [27-11-9 NMSA 1978] through 11 […]
Section 27-11-5 – Rules.
The secretary shall adopt and promulgate rules appropriate to administer, carry out and enforce the provisions of the Medicaid Provider Act. History: Laws 1998, ch. 30, § 5.
Section 27-11-6 – Repealed.
History: Laws 2004, ch. 4, § 1; repealed by Laws 2006, ch. 25, § 2. ANNOTATIONS Repeals. — Laws 2006, ch. 25, § 2 repealed 27-11-6 NMSA 1978, as enacted by Laws 2004, ch. 4, § 1, relating to the imposition of a daily bed surcharge, effective March 2, 2006. For provisions of former section, […]
Section 27-11-7 – Determination of overpayments or credible allegation of fraud; audit findings; sampling; extrapolation limited; notice of right to informal conference and expedited adjudicatory proceeding.
A. The department may audit a medicaid provider or subcontractor for overpayment, using sampling for the time period audited. If the department contracts for the audit, the department shall contract only with an independent auditor approved by the state auditor. Each audited claim shall be reviewed by a person who is licensed, certified, registered or […]
Section 27-11-8 – Informal conference; corrective action; requirements.
A. A medicaid provider or subcontractor seeking an informal conference pursuant to this section shall serve the department with a written request for such conference no later than thirty calendar days following the service of a preliminary determination of overpayment by the department on the medicaid provider or subcontractor. Upon receipt of a request for […]
Section 27-11-9 – Expedited adjudicatory proceedings; requirements.
A. A medicaid provider or subcontractor seeking an expedited adjudicatory proceeding pursuant to the Medicaid Provider and Managed Care Act shall serve the department and the administrative hearings office with a written request for such proceeding no later than thirty calendar days following the service of a final determination of overpayment by the department on […]
Section 27-11-10 – Qualifications and selection of hearing officer for expedited adjudicatory proceedings.
A. The hearing officer presiding over the expedited adjudicatory proceeding held pursuant to the Medicaid Provider and Managed Care Act shall: (1) be licensed and in good standing to practice law in New Mexico or another state; (2) have at least three years’ cumulative experience in one or more of the following areas: the health […]