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Gambled and Lost

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

The owner of a personal care agency in Gallup, New Mexico apparently had a gambling habit. Either that, or she just liked to frequent casinos to withdraw money from their ATMs. There’s nothing wrong with that per se, except that Lolita Begay-Yazzie withdrew $85,000 from her company’s bank account containing proceeds received from Medicaid. (Something is amiss here.)

According to New Mexico’s Attorney General, Hector Balderas, nearly half of the state’s residents are Medicaid beneficiaries. Begay-Yazzie overbilled New Mexico Medicaid for some of those beneficiaries and illegally collected more than $400,000.

She billed the government healthcare program as if her employees were providing care services for more than 24 hours a day. (That would require clones, and everyone knows that’s not possible, unless you’re Dolly the Sheep.) She also overbilled Medicaid for more services than their individual care plans required.

As of this month, Begay-Yazzie pleaded guilty to 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. (Whether or not she has a gambling problem remains to be seen, but she has definitely gambled with her future and lost.)

If you suspect Medicare or Medicaid fraud, please report it by calling 1-800-447-8477 or send an email via to HHSTips@oig.hhs.gov.

Today’s Fraud of the Day comes from an article, “AG’s Office: Gallup agency owner pleads guilty to Medicaid fraud,” published by KRQE, on January 8, 2021.

SANTA FE, N.M. (KRQE) – The New Mexico Office of the Attorney General reports that it has secured a guilty plea from Lolita Begay-Yazzie to one count of fraud in excess of $20,000 and one count of failure to retain documents for defrauding New Mexico’s Medicaid program of over $40,000. According to the Office of the Attorney General, Begay-Yazzie owned and operated a personal care agency in Gallup, New Mexico.

“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,” said Attorney General Hector Balderas. “We will continue to hold anyone who tries to steal these critical healthcare resources accountable.”

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