{"data":{"id":"us-nm/27-11-16","jurisdiction":"us-nm","citation":"27-11-16","heading":"Credible allegation of fraud; judicial review; substantial evidence required.","body":"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.\nB. 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:\n(1) it has followed its own procedures; and\n(2) the evidence relied upon to make its credible allegation of fraud determination was relevant, credible and material to the issue of fraud.\nC. 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.","path":["Chapter 27 - Public Assistance","ARTICLE 11 Medicaid Providers"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18527/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:19Z","sha256":"ffa7483face824e8abc4b13f1f3dc88af2694c6af9556e033d074b8dafe24141","source_id":"us-nm","stale":false,"prev":"us-nm/27-11-15","next":"us-nm/27-11-17"},"notice":"GroundRules: Original legal text. Not legal advice."}