AG Balderas Calls for Federal Policy Change to Expand State’s Medicaid Fraud Authority to Address More Home Healthcare Abuse Cases


Contact: James Hallinan (505) 660-2216

Las Cruces, NM – Yesterday, Attorney General Hector Balderas and the National Association of Attorneys General (NAAG) sent a letter urging the U.S. government to change its policy so that state attorneys general can use federal funds to investigate and prosecute a wider range of Medicaid abuse and neglect cases, including those that happen at home. Medicaid is a joint federal-state program that provides free or low-cost medical benefits to millions of Americans. More than 6.4 million people enrolled in the Medicaid program are age 65 or older. According to the Centers for Disease Control and Prevention, 1 in 10 persons age 65 and older who live at home will become a victim of abuse.

“My office will continue to aggressively investigate and prosecute instances of Medicaid fraud and resident abuse to protect New Mexico’s seniors and vulnerable populations, but the federal government must not stand in our way,” Attorney General Hector Balderas said. “Last year alone, our office brought in over $6 million through our Medicaid Fraud Control Unit, but we need more flexibility from the federal government to protect New Mexicans with disabilities and our senior citizens who are receiving care at home.”

Medicaid Fraud Control Units (MFCUs) investigate and prosecute state Medicaid provider fraud and resident abuse complaints in Medicaid-funded health care facilities. They have the option to review abuse and neglect complaints of those residing in board and care facilities. In most states, MFCUs operate in the state attorney general’s office.

“…the current strict federal limitations on states’ ability to use MFCU assets to investigate abuse and neglect are outdated, arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated,” reads the NAAG letter. NAAG offered two recommendations:

  • Allow MFCU federals funds to be used to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutional settings (i.e. home health care).
  • Allow use of MFCU federal funds to freely screen or review any and all complaints or reports of whatever type, in whatever setting.

The NAAG letter was signed by Attorney General Hector Balderas and attorneys general in 37 states and the District of Columbia, and was sent to the U.S. Department of Health and Human Services Secretary Tom Price.

Please see attached for a copy of the letter that was sent yesterday.

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