New Mexico Woman Pleads Guilty to $4M Medicaid Fraud

A New Mexico woman pleaded guilty today to working with a non-emergency medical transport (NEMT) company to submit millions of dollars in false and fraudulent claims to New Mexico Medicaid for ineligible and non-existent trips to medical appointments. According to court documents, Dorothea Irving, 47, of Farmington, New Mexico, worked as a driver between 2020 and 2026 for a company that provided non-emergency medical transportation. The New Mexico Medicaid program covers the cost of transportation for non-emergency medical services, such as routine doctors’ appointments, for Medicaid recipients who lack access to transportation by personal vehicle or public transportation. Instead of driving Medicaid beneficiaries who lacked transportation to their medical appointments, Irving and the company engaged in a multi-year scheme to submit fraudulent claims for purported transportation provided to Irving and her children. Together with the company, its owner, and other employees and drivers, Irving submitted false trip records claiming that she or her children were the Medicaid beneficiaries without transportation, claiming trips that had not occurred, and claiming to have been an attendant for her children on their own trips. Irving and other drivers also signed trip forms falsely representing to have driven each other to appointments to disguise the fact that they were driving themselves. In many instances, the fraudulent trips involved Irving, another driver, or minor children purportedly traveling to Alcoholics Anonymous meetings across New Mexico at great distances. The NEMT company used the false trip records to submit millions of dollars in fraudulent claims to New Mexico Medicaid, including false claims that each passenger in the vehicle had taken a separate trip. For the trips taken by Irving and her children as the supposed Medicaid recipient without transportation, the company submitted fraudulent claims of approximately $3,957,788 and received approximately $4,142,942 from Medicaid. Irving herself received approximately $980,901 from the company over four years of the scheme. Irving pleaded guilty to conspiracy to commit health care fraud.