ABOUT THE DEPARTMENT

We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Office of Inspector General

Adrian R. Gallegos, Inspector General

The mission of the Office of the Inspector General (OIG) is to prevent and detect fraud, waste and abuse in the New Mexico Health Care Authority (HCA’s) public assistance programs and services, and internal operations. The OIG conducts financial and program audits, criminal, civil, and administrative investigations, special reviews, and administers the Medicaid Program Integrity Unit and Public Assistance Reporting Information System (PARIS) programs. The OIG is comprised of the Internal Review Bureau, Investigations Bureau, and Central Office.

Main Office

Office of Inspector General
P.O. Box 2348
Santa Fe, NM 87504

Call: (505) 827-8141

1 (800) 228-4802

Report Fraud

For instructions on how to report fraud, waste, or abuse concerning an HCA program, please click here.

Audit Bureau (AB) – Acting Bureau Chief Eric Marquez

The OIG’s Audit Bureau conducts financial and program compliance audits of HCA, as well as performance evaluations. The AB provides investigative support to the OIG’s Investigations Bureau and specialized computer forensics expertise. The AB houses the Medicaid Program Integrity Unit (MPIU) who processes Medicaid provider complaints and refers credible allegations of provider fraud to the New Mexico Office of the Attorney General’s (OAG’s), Medicaid Fraud Control Division (also known as the Medicaid Fraud Control Unit). The MPIU also conducts audits of provider Medicaid claims to identify potential overpayments, and minimize fraud and abuse.

Investigations Bureau (IB) – Bureau Chief Eric Marquez

The OIG’s Investigations Bureau conducts criminal, civil and administrative investigations into allegations of participant public assistance and Medicaid provider fraud, and conducts HCA employee integrity investigations that result from allegations of potential misconduct. The IB houses the OIG’s Technology Crimes Unit that provides computer forensic support to investigations. The IB conducts joint investigations with other state and federal law enforcement agencies, and refers matters of potential fraud to the New Mexico District Attorney Offices throughout the state, the OAG, or the U.S. Attorney’s Office for the District of New Mexico for prosecutive consideration.

Central Office (CO)

The OIG’s Central Office provides administrative support and administers the OIG’s Hotline and PARIS programs. Pursuant to the Hotline program, the CO is responsible for the intake and processing of allegations concerning public assistance fraud in HCA programs and services, and the intake and processing of allegations concerning potential fraud, waste or abuse in HCA’s operations. The CO administers the PARIS program which matches participants of public assistance in two or more states for the purpose of identifying potential improper payments, and minimizing fraud and abuse. The CO oversees the OIG budget, and assists the Inspector General with special projects and assignments.

For PARIS Contacts and Inquiry

Please use the “Main Office” address above or

Call: (505) 827-8189

Fax: (505) 827-8165