U.S. Virgin Islands — Attorney General Denise George announces the arrest of Kathleen Gussie by the V.I. Dept. of Justice (“VIDOJ”) on January 15, 2021, during a Press Briefing. Gussie is a former Medicaid eligibility supervisor at the V.I. Dept. of Human Services (“DHS”).
V.I. Department of Justice special agents arrested Gussie on a warrant signed by the V.I. Superior Court Magistrate on St. Croix. She is charged with several counts of Medicaid Program fraud which she is alleged to have committed while she held the position at the DHS as the Supervisor of the eligibility unit. These incidences occurred between December 11, 2017, to July 2018. Gussie is charged with Embezzlement by Public and Private Officers, Embezzlement or Falsification of Public Accounts, Fraudulent Claims Upon the Government, and Conversion of Government Property.
According to an affidavit in support of the arrest warrant, the investigation revealed that Gussie fraudulently obtained and used Medicaid funds for her benefit when she knew she was not lawfully eligible for Medicaid benefits. Gussie was released on January 15, 2021, after posting 10% of the $50,000 bond.
AG George said this is the first of more arrests and prosecution deriving from the Medicaid Fraud Control Unit (“VIMFCU”) at the V.I. Department of Justice. “This is the first arrest, and we expect there will be many more. Within the last year alone, after being fully staffed with an investigator, analyst, director, and a legal assistant, we have gotten a substantial number of cases and complaints,” said AG George.
VIMFCU is required under both federal and territorial law, to partner with the Virgin Islands Department of Human Services to combat waste, fraud, and abuse in the Medicaid program. DHS and VIDOJ entered a Memorandum of Understanding (“MOU”), wherein DHS agreed to refer all suspected cases of Medicaid fraud, abuse, and/or neglect to VIMFCU. VIMFCU will also partner with DHS to revise policies or make programmatic or legislative changes to the Medicaid program
V.I. Dept of Human Services Commissioner, Kimberley Causey-Gomez provided a statement during Friday’s briefing. She said, “As demonstrated by today’s events, the Dept. of Human Services and our team’s leadership will not tolerate fraud, waste or abuse in any of our divisions, especially Medicaid, as we exist to serve our most vulnerable populations.”
VIMFCU was created as a division within the Virgin Islands Department of Justice as a result of federal legislation authorizing the states and Territories to investigate and prosecute fraud and abuse in Medicaid. It was first certified in DOJ in December 2018 and has been re-certified every year since. Medicaid Fraud Control Units, such as the one in the Territory, operate in all 50 states, the District of Columbia, and Puerto Rico. The Division is 100% funded by a grant from the United States Department of Health and Human Services, Office of the Inspector General. It protects the Territory and its taxpayers by investigating and prosecuting fraud committed by those health care providers and facilities that provide services paid by Medicaid. Also, the VIMFCU protects the most vulnerable in this community by investigating and prosecuting complaints of elder and resident abuse or neglect in nursing homes, adult family homes, and assisted living. VIMFCU also makes recommendations to the U.S. Department of Health and Health and Human Services, Office of the Inspector General to exclude individuals or entities from participating in federally funded programs.
VIMFCU has authority under both federal and local laws to hold medical providers or entities accountable through criminal prosecution and/or civil litigation. Providers can include physicians (medical doctors), dentists, nursing or convalescent homes, medical equipment supply companies, taxi, and other transportation companies, or anyone else who bills the Virgin Islands Medicaid program for health care services provided to a Medicaid recipient.
To report fraud, the VIMFCU has a confidential phone number, 1 888-404-6328 and email, email@example.com.
AG George cautions the public that any person charged with a crime in the Virgin Islands is considered to be innocent until proven guilty by a court of competent jurisdiction.
Also, in attendance were V.I. Department of Justice Medicaid Fraud Control Unit Director, Assistant Attorney General Julita Deleon, and Attorney Carol Thomas-Jacobs, Chief Deputy Attorney General.
January 16, 2021
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