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Editorial: NM Medicaid fraud recovery improves

In the months before ramping up his gubernatorial campaign, Attorney General Gary King finally got his Medicaid Fraud Unit to do better than barely break even – much better, in fact.

Yet the timing is irrelevant to the taxpayers who year after year have been getting taken, primarily by big providers who defraud a system that’s supposed to protect and care for the health of the poor and disabled. The public just wants its money back so it can be used for its intended purpose – especially with an estimated one in every three New Mexicans expected to be on Medicaid under the Affordable Care Act.

In fiscal 2010, three years after taking office as New Mexicans’ top lawyer, King’s unit spent $1.8 million to recover $2.4 million – in other words, it made 33 cents for every buck of public money it spent, though there’s an estimated $75 million worth of fraud here annually.

Meanwhile, the national recovery average was $10 for every $1 spent, meaning New Mexico ranked near the bottom nationally on this return on investment.

The unit’s poor performance was ripped by a Legislative Finance Committee report in the summer of 2010, leading to news stories and critical editorials. Things have changed for the better, and for that King deserves credit.

In 2013, LFC staff issued a follow-up report citing improvements, including additional staff training for staff, investigation prioritization and reduced caseload, and since October the unit has recovered nearly $9 million – more than in the three previous years combined.


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It’s important to note that the Department of Human Services, which oversees Medicaid dollars here, has also strengthened its efforts to detect fraud, that cases and settlement negotiations take months if not years to play out, and there are always going to be more folks trying to take advantage of a system than enforcing it.

Under the heading of better late than never, New Mexico taxpayers benefit from the changes.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.