NM woman pleads guilty in $4M Medicaid fraud scheme

A Farmington woman has pleaded guilty in federal court after prosecutors say she helped carry out a years-long Medicaid fraud scheme involving fake and ineligible non-emergency medical transportation trips across New Mexico.

Dorothea Irving, 47, pleaded guilty Monday to conspiracy to commit health care fraud, according to the U.S. Department of Justice. Prosecutors say Irving worked with a non-emergency medical transportation company to submit millions of dollars in false claims to New Mexico Medicaid for trips that either did not happen or were not eligible for reimbursement.

The alleged scheme took place between 2020 and 2026, while Irving worked as a driver for a company that provided non-emergency medical transportation, commonly known as NEMT.

New Mexico Medicaid covers transportation for eligible Medicaid recipients who need help getting to non-emergency medical services, such as routine doctor appointments, when they do not have access to a personal vehicle or public transportation.

But according to court documents, Irving and others used the program as part of a multi-year fraud scheme.

Instead of simply transporting Medicaid beneficiaries to legitimate medical appointments, Irving, the company, its owner, employees, and other drivers submitted false trip records claiming that Irving or her children were Medicaid beneficiaries who needed transportation. Prosecutors say the false records included trips that never happened, claims that Irving acted as an attendant for her children on their own trips, and paperwork in which drivers falsely claimed to have transported one another to appointments.

Federal prosecutors said those records were used to disguise the fact that drivers were actually driving themselves.

In many cases, the fraudulent trip records involved Irving, other drivers, or minor children supposedly traveling long distances across New Mexico to Alcoholics Anonymous meetings.

The DOJ said the NEMT company then used the false trip records to submit millions of dollars in fraudulent claims to New Mexico Medicaid. In some cases, the company allegedly claimed each passenger in a vehicle had taken a separate trip, multiplying the amount billed to taxpayers.

For trips involving Irving and her children as the supposed Medicaid recipients without transportation, the company submitted approximately $3,957,788 in fraudulent claims and received approximately $4,142,942 from Medicaid, according to the Justice Department.

Irving herself received approximately $980,901 from the company over four years of the scheme.

The guilty plea marks another major Medicaid fraud case in New Mexico, where taxpayer-funded programs have repeatedly drawn scrutiny over waste, fraud, and weak oversight. The case also highlights how programs intended to serve vulnerable patients can be exploited when providers and insiders manipulate billing records.

Irving faces a maximum penalty of 10 years in prison. A sentencing date has not yet been scheduled. Her sentence will be determined by a federal district court judge after review of the U.S. Sentencing Guidelines and other legal factors.

The case is being investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General, IRS Criminal Investigation, and the New Mexico Medicaid Fraud Control Bureau.

The announcement was made by Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division; FBI Albuquerque Special Agent in Charge Justin A. Garris; HHS-OIG Special Agent in Charge Jason E. Meadows; IRS-CI Acting Special Agent in Charge Scott Brown of the Phoenix Field Office; and New Mexico Medicaid Fraud Control Bureau Director Jessica Randall.

Trial Attorney Lauren Randell of the Justice Department’s Criminal Division Fraud Section and Assistant U.S. Attorney Katherine Lewis for the District of New Mexico are prosecuting the case.

The DOJ noted that the case falls under its broader effort to crack down on fraud against federal benefit programs. In April, the department announced the creation of the National Fraud Enforcement Division, which it described as “laser-focused” on investigating and prosecuting fraud against the American people.

That work supports President Donald Trump’s Task Force to Eliminate Fraud, a government-wide effort chaired by Vice President J.D. Vance targeting fraud, waste, and abuse in federal benefit programs.

Since 2007, the DOJ’s Health Care Fraud Strike Force Program has charged more than 6,200 defendants accused of collectively billing federal health care programs and private insurers more than $45 billion.

For New Mexico taxpayers, the Farmington case is another reminder that Medicaid fraud is not a victimless crime. Every dollar siphoned through false claims is money taken from a program meant to help people who actually need care.