Medicaid Fraud Major Cases

Laurel Canyon Nursing Home:
In 2009 the Medicaid Fraud & Elder Abuse Division obtained a criminal felony conviction against a nursing home company for abuse and neglect of one of its residents. The case involved the abuse and neglect of a resident admitted to the Laurel Canyon Nursing Home on December 23, 2005. While at the nursing home the resident was left on a bedpan for approximately twenty-four hours. The bedpan became imbedded in the resident’s skin and left a wound in the shape of the bedpan when removed. The injury was later assessed as a Stage II pressure ulcer. The MFEAD successfully argued the wound was caused by willful disregard and reckless acts and omissions by the nursing home’s management staff.  Criminal prosecutions of nursing home companies for abuse or neglect of residents are rare nationwide. This conviction at trial of a nursing home company is believed to be the first of its type by a state prosecutor’s office.

Counseling and Mediation, LLC:
The Medicaid Fraud and Elder Abuse Division (MFEAD) successfully prosecuted all defendants indicted in a case involving fraudulent conduct at a mental health agency.  The business called Counseling and Mediation, LLC, owner Arcilia Holguin, program director Lazaro Molina, and field supervisor Juana Barba, were all indicted by a Las Cruces grand jury in April of 2010 on charges of Medicaid Fraud, Fraud, and various other related charges.  The criminal conviction of a business entity for Medicaid Fraud is believed to be the first of its kind in the State of New Mexico.  Juana Barba plead guilty in March of 2011 to charges of Medicaid Fraud and Forgery.  Barba testified at the trials of Molina, Holguin, and Counseling and Mediation, LLC.  Holguin and her business were tried together in November of 2011 and were both found guilty; Lazaro Molina was tried separately in June 2011 and was also convicted.  Testimony at trial showed intentional and outrageous over-billing, failure to provide adequate mental health services to the children that were intended to benefit from the service, and intentional alteration of documentation to reflect that a valid service was being performed.

The Medicaid Fraud and Elder Abuse Division prosecuted married couple Catherine and Joseph Hernandez of Medicaid Fraud in their billing for the care of their son Joseph, Jr.  The couple was found to have exaggerated the needs of their son, who was diagnosed with spina bifida. The son maintained a full-time job as a parking attendant and lived in his own residence from 2006 forward.  Joseph, Jr. also maintained a long-term relationship with a woman who occasionally lived with him during the relevant time period.  Despite their son maintaining a full-time job, having his own residence, and maintaining a busy and active social life, Catherine and Joseph Hernandez frequently billed for 40 hours/week of care for Joseph, Jr.  During one time period, Catherine Hernandez billed for a service calling for 24-hour care, and requiring the recipient of the service (her son in this case) to live with the person providing the service.  During part of the time she billed Medicaid for this service, Catherine Hernandez' son was living on his own and working full time.  The outcome of this case sends a clear message that such abuse of Medicaid funds will not be tolerated, especially when so many others are in need.