N.M. Stat. § 27-11-13
Release of suspended payment for services previously
rendered; prepayment review; remedial training and education;
temporary assistance.
A. The department shall direct the release of a suspended payment to a medicaid
provider or subcontractor that is the subject of a referral based upon a determination of
a credible allegation of fraud for services previously rendered if the medicaid provider or
subcontractor posts a surety bond in the amount of the suspended payment, which
posting shall be deemed good cause not to suspend payment.
B. The provisions of this section shall not prevent the department from:
(1)
conducting a prepayment review of claims for ongoing services rendered
by the medicaid provider or subcontractor;
(2)
requiring the medicaid provider or subcontractor or its employees to
complete remedial training or education to prevent the submission of claims for payment
to which the medicaid provider or subcontractor is not entitled; or
(3)
requiring the medicaid provider or subcontractor to engage an
independent third party approved by the department to temporarily manage or provide
technical assistance to the medicaid provider or subcontractor.
C. The department shall direct that the release of a suspended payment occur no
later than ten business days following the earlier of:
(1)
the posting of a surety bond by the medicaid provider or subcontractor in
the amount of the suspended payment;
(2)
notice from the attorney general that the attorney general will not pursue
legal action against the medicaid provider or subcontractor arising out of the referral of
the medicaid provider or subcontractor based on a determination of a credible allegation
of fraud;
(3)
the date on which an administrative decision as to the basis for
suspending such payments, or portion of such payments, in favor of the medicaid
provider or subcontractor becomes final; or
(4)
the date on which a judicial decision as to the basis for suspending such
payments, or portion of such payments, in favor of the medicaid provider or
subcontractor becomes final and not subject to further appeal.