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 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, and special reviews, and administers the Medicaid Program Integrity Unit and the Public Assistance Reporting Information System (PARIS) program. The OIG is comprised of the Audit Bureau, Medicaid Program Integrity Unit, Investigations Bureau, and Central Office.

Central Office

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

Call: (505) 827-8141 or

1 (800) 228-4802

Report Fraud

For instructions on how to report fraud, waste, or abuse concerning an HCA public assistance program, HCA operation, HCA contractor or grantee, or Medicaid provider, please click here.

Audit Bureau – Acting Bureau Chief Eric Marquez

The OIG’s Audit Bureau (AB) conducts financial and program compliance audits of HCA, and HCA contractors and grantees, as well as performance evaluations. The AB provides investigative support to the OIG’s Investigations Bureau.

Medicaid Program Integrity Unit

The OIG’s Medicaid Program Integrity Unit (MPIU) process Medicaid provider complaints and refers credible allegations of provider fraud to IB for investigations or to the New Department of Justice (NMDOJ), Medicaid Fraud and Elder Abuse Division (also known as the Medicaid Fraud Control Unit) for prosecutive consideration. The MPIU also conducts audits of provider Medicaid claims to identify potential overpayments, and minimize fraud, waste and abuse. The MPIU also oversees the Medicaid program integrity operations for HCA’s Managed Care Organizations.

Investigations Bureau – Bureau Chief Eric Marquez

The OIG’s Investigations Bureau (IB) 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 forensic computer 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 NMDOJ, or the U.S. Attorney’s Office for the District of New Mexico for prosecutive consideration.

Central Office

The OIG’s Central Office (CO) is the OIG’s main point of contact and 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 potential public assistance fraud in HCA programs and services, and 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, waste and abuse. The CO oversees the OIG’s 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 or

Fax: (505) 827-8165