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Thursday, June 20, 2024
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Health Care Fraud Awareness Campaign Focuses on Medicare/ Medicaid

Attorney General Denise George (Photo by Barry Leerdam, Legislature of the Virgin Islands.)

Attorney General Denise George announces that efforts by the Virgin Islands Health Care Fraud Task Force are underway to educate and inform V.I. Medicare and Medicaid beneficiaries of their rights under each program.

The task force focuses on issues relating to Medicare and Medicaid fraud, financial exploitation of vulnerable persons and abuse or neglect of elderly persons.

To reach beneficiaries, task force members will appear on local radio and television during March to discuss beneficiaries’ rights, available resources to help them navigate the complexities of medical billing, as well as the work of the task force, including its efforts to combat fraud, waste and abuse in the Medicare and Medicaid programs.

The task force meets quarterly via an online platform. Over the past several months, members have been meeting in committee to create the communication strategy.

Fraud in the territory’s health care system results in significant financial losses in the Medicare and Medicaid programs. Health care fraud occurs when an individual, a group of people or a company knowingly misrepresents or misstates something about the type, the scope or the nature of the medical treatment or service provided in a manner that could result in unauthorized payments being made. Examples of health care fraud include:

  • Billing for services not rendered or goods not provided;
  • Falsifying certificates of medical necessity and billing for services not medically necessary;
  • Billing separately for services that should be included in single service fees;
  • Falsifying plans of treatment or medical records to justify payments;
  • Misrepresenting diagnoses or procedures to maximize payments;
  • Misrepresenting charges or entitlements to payments in cost reports; and
  • Soliciting “kickbacks” for the provision of various services or goods.

The Virgin Islands Department of Justice and the United States Attorney’s Office partnered last year to create the task force. In addition, the task force comprises the Federal Bureau of Investigation, Disability Rights Center of the Virgin Islands, Virgin Islands Senior Medicare Patrol, Department of Human Services Medicaid Program, Center for Medicare and Medicaid Services, and the U.S. Department of Health and Human Services, Office of the Inspector General.

The Medicaid Fraud Control Unit, a division of the V.I. Department of Justice, investigates allegations of provider fraud and prosecutes Medicaid fraud, financial exploitation, abuse and neglect.

The U.S. Attorney’s Office is committed to protecting victims of health care fraud, safeguarding taxpayer dollars and ensuring the integrity of the health care system. Combatting criminal and civil health care fraud is a top priority of the department.

The FBI is the primary agency for exposing and investigating health care fraud, with jurisdiction over both federal and private insurance programs.

The Disability Rights Center of the Virgin Islands assists Medicare recipients with issues or concerns relating to an authorized representative.

The Virgin Islands Senior Medicare Patrol educates beneficiaries regarding how to prevent, detect and report health care fraud, including how to protect their identity, identify deceptive health care practices, and identify errors on health care bills.

The Center for Medicare and Medicaid Services administers the Medicare and Medicaid programs.

The mission of HHS-OIG as mandated by the Inspector General Act is to protect the integrity of HHS’s programs as well as the well-being of the beneficiaries of those programs.


V.I. Dept. of Justice Medicaid Fraud Control Unit: anonymous hotline (888)-404-MFCU (6328) or email mfcu@doj.vi.gov.

FBI, U.S. Health and Human Services’ Office of the Inspector General or the U.S. Attorney’s Office: Please contact HHS-OIG at 1-800-447-8477 or NYCOIFOSanJuan@oig.hhs.gov; the FBI at 777-3363 or www.tips.fbi.gov and the U.S. Attorney’s Office at 774-5757.

The V.I. Disability Rights Center: Attorney Kippy Roberson 772-0609.Virgin Islands Senior Medicare Patrol (SMP): Aimee Griles at (877)-784-0228 or agriles@lsvilaw.org.

Center for Medicare and Medicaid Services (CMS): Marina Diaz, CMS Director for Puerto Rico and the Virgin Islands at Marina.Diaz@cms.hhs.gov.

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