Fraud case tossed over investigator’s conduct

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SANTA FE, N.M. (AP) - The state Court of Appeals has upheld the dismissal of a Medicaid fraud case as a sanction for the attorney general’s office creating and using a false document in pursuing claims against a health care company.

Phil Sisneros, a spokesman for Attorney General Gary King, said Wednesday the office hasn’t decided whether to appeal the ruling to the state Supreme Court. “However, we do believe a complete dismissal of the fraud case was not the correct and just way to go,” Sisneros said in a statement.

In a ruling on Monday, the Court of Appeals affirmed an Albuquerque district judge’s decision in 2011 to dismiss the fraud claims and prevent the case from being refiled.

The court said the judge “was presented with severe misconduct, prejudicial to the administration of justice. The circumstances are ironic in that the state was prosecuting a claim of fraud using created, false documents to do so.”

At issue were letters an attorney general’s investigator had prepared by an agency to show when criminal background checks were completed for caregivers of Advantageous Community Services, an Albuquerque company that provided home-based health care services.

The letters weren’t copies of the originals from 2006, but were recreated at the request of the investigator from the Health Department’s computer records because the agency no longer kept paper copies and couldn’t reprint an exact copy of the originals.

The department provided an explanation to the investigator for differences in the letters, but the investigator didn’t provide that information to the assistant attorney general prosecuting the case or tell the prosecutor that the documents weren’t authentic copies.

Information was correct about the names of the caregivers and the dates they cleared their background checks. But the documents obtained by the investigator had an updated Department of Health letterhead from Gov. Susana Martinez’s administration rather than when Gov. Bill Richardson was in office in 2006. The text of the letters differed from the originals, and the names of department and company officials also were different.

The court said the letters were critical because the attorney general’s office was pursuing allegations that the company received Medicaid payments for services by caregivers before they obtained proper clearance from the background check.

Sisneros said the investigator, whose name wasn’t included in the Appeals Court ruling, is voluntarily leaving the attorney general’s office next week for another job but the move wasn’t related to the court case. The investigator previously had been transferred to a different assignment within the Medicaid Fraud and Elder Abuse Division, he said.

The court’s ruling comes as King’s office is investigating allegations of fraud, mismanagement and billing problems by more than a dozen nonprofit providers of mental health services through the Medicaid program.

The Martinez administration suspended payments to the providers last year, and some of them have gone out of business because of the billing disputes with the state. The health care company involved in the Court of Appeals ruling is not among the providers currently being investigated for Medicaid fraud, however.

Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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