Balderas Secures Conviction Of Former Personal Care Organization Owner Who Defrauded Medicaid Program

Attorney General Hector Balderas

AG News:

SANTA FE — Attorney General Hector Balderas announced that his office has secured a guilty plea from Lolita Begay-Yazzie to one count of Fraud in excess of $20,000, a second degree felony, and one count of Failure to Retain Documents, a fourth degree felony for defrauding New Mexico’s Medicaid program of more than $400,000.

Begay-Yazzie owned and operated a personal care agency in Gallup.

“Medicaid ensures that almost half of all New Mexicans have access to healthcare, and we must do all we can to protect these resources that are so vital to our families,” Balderas said. “We will continue to hold anyone who tries to steal these critical healthcare resources accountable.” 

Begay-Yazzie billed New Mexico Medicaid as if her employees were providing care services in excess of 24 hours in a day. Begay-Yazzie also overbilled Medicaid for more services than each patient required to meet their needs according to their care plan. Begay-Yazzie made withdrawals at ATMs in casinos in excess of $85,000 from the personal care agency account. 

The Court has ordered a pre-sentence report and will hold a sentencing hearing in the coming months. According to the terms of the plea, Begay-Yazzie faces up to five years of incarceration, and will be excluded from providing any Medicaid services in the future.

This case was investigated and prosecuted by the Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU). The MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,200,478 for Federal fiscal year (FY) 2019-20, of which $2,400,360 is federally funded. The remaining 25 percent of the approved grant, totaling $800,118 for FY 2019-20, is funded by the State of New Mexico.