Gainwell Technologies Deploys Comprehensive HMS Fraud, Waste, and Abuse Suite to Strengthen Medicaid Program Integrity in New Mexico  

State modernizes quality assurance and expands tools to bolster program integrity and access to care 

IRVING, Texas – April 8, 2026 — Gainwell Technologies LLC today announced that New Mexico has deployed a comprehensive suite of the Health Management Systems, Inc. (HMS) program integrity and quality assurance capabilities to support the state’s modernization efforts and strengthen its fight against fraud, waste, and abuse (FWA) across the Medicaid program. 

The state’s new HMS capabilities bring together fraud detection, quality assurance, residency verification, clinical claim review, and eligibility integrity into a unified approach that strengthens oversight and protects Medicaid resources for the New Mexicans who rely on them. 

“New Mexico is taking very significant steps to detect and ultimately prevent fraud, waste, and abuse, preserving Medicaid for the people it is intended to serve,” said Greg Fischer, HMS SVP, FWA. “This suite of HMS capabilities from Gainwell gives the state the modern tools needed to detect issues earlier and with more precision to better support high quality care.” 

HMS capabilities now live in New Mexico include: 

• Fraud, waste, and abuse detection powered by HMS FraudCapture®, a cloud-hosted platform that supports Special Investigations Unit (SIU) operations with guided analytics, link visualization, provider and member profiling, and end-to-end workflow management. 

• Residency and eligibility verification, including out-of-state identification not captured by PARIS, utility-based residency validation, member outreach, documentation review, and capitation recovery—giving the state real-time visibility into emerging risks and potential overpayments. 

• Coordination of Benefits (COB) on Demand, ensuring Medicaid remains the payer of last resort. 

• Clinical Claim Reviews (CCR) using advanced analytics, machine learning, and expert clinical staff to support consistent pre and postpay determinations. 

“As we work to protect Medicaid resources and ensure they reach the New Mexicans who need them most, this partnership gives us the advanced tools and insight required to strengthen oversight and improve accuracy,” said Paula Morgan, New Mexico HCA Chief Information Officer. 

The implementation also supports New Mexico’s Quality Assurance modernization initiative, incorporating National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®) quality measures and CMS Core Set quality measures to streamline reporting and strengthen statewide quality oversight. 

Gainwell and HMS will continue partnering with New Mexico to optimize the solution and support ongoing program integrity and modernization efforts across the Medicaid enterprise. 

About Gainwell Technologies 
Gainwell Technologies LLC is the trusted leader in digital and cloud-enabled solutions for health and human services programs. With over 50 years of proven expertise, Gainwell helps modernize Medicaid and public health programs with innovative solutions to improve operational efficiency and enhance provider experiences. Through Health Management Systems, Inc. (HMS), a Gainwell-affiliated company, the organization also safeguards program integrity by providing essential verification and cost containment services. Combining cutting-edge technology with an unwavering commitment to service excellence, Gainwell delivers scalable, impactful solutions that advance public health and create transformational results. Learn more at gainwelltechnologies.com. 

Media Contact 
Cecile Fradkin, S&C PR for Gainwell, cfradkin@scprgroup.com.