CONFIDENTIAL REPORTING: P. 888-404-6328 E. MFCU@doj.vi.gov
THE MEDICAID FRAUD CONTROL UNIT OF THE VIRGIN ISLANDS DEPARTMENT OF JUSTICE (VIMFCU) investigates and prosecutes fraud committed by health care providers who provide services paid for by Medicaid, the Territory’s health insurance program for its economically disadvantaged residents. VIMFCU also has jurisdiction to seek civil recovery of fraudulently obtained Medicaid dollars.
Providers may include physicians (medical doctors), dentists, nursing or convalescent homes, medical equipment supply companies, taxi and other transportation companies, or anyone who bills the Virgin Islands Medicaid Program for health care services provided to a Medicaid recipient.
Some examples of the types of fraud that can take place include:
- Billing for treatment, medical procedures or equipment that is not actually performed or provided. Double billing, which means billing both the Medicaid program and the recipient or his or her private insurance for the same service. Billing for services that are not medically required.
- Filling a prescription with a generic drug while billing Medicaid for the higher priced brand-name drug.
- Kickbacks, or giving or accepting something in return for medical services.
- “Up-coding,” which is billing Medicaid for a more expensive procedure or service than was actually performed or provided.
In addition, the Medicaid Fraud Control Unit is responsible for the investigation and prosecution of cases of suspected abuse/neglect and/or exploitation of vulnerable persons/elders.
WHERE TO REPORT SUSPECTED FRAUD & ABUSE
Report Medicaid provider fraud and/or abuse/financial exploitation to the Virgin Islands Medicaid Fraud Control Unit at (888)-404-MFCU (6328) or MFCU@doj.vi.gov