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. A sentencing date has not been set and she faces a maximum penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division; Special Agent in Charge Justin A. Garris of the FBI Albuquerque Field Office; Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG); Acting Special Agent in Charge Scott Brown of the IRS Criminal Investigation’s Phoenix Field Office (IRS-CI); and Director Jessica Randall of the New Mexico Medicaid Fraud Control Bureau made the announcement.
FBI, HHS-OIG, IRS-CI, and the New Mexico Medicaid Fraud Control Bureau are investigating the case.
Trial Attorney Lauren Randell of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Katherine Lewis for the District of New Mexico are prosecuting the case.
On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division (“Fraud Division”). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department’s work to combat fraud supports President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.
The Department of Justice’s Health Care Fraud Strike Force Program, currently comprised of nine strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion since 2007. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.
