(a) There is established within the Office of the Attorney General, the Medicaid Fraud Control Unit.(a) The Department of Human Services or its fiscal agents shall refer all cases of suspected Medicaid fraud to the Medicaid Fraud Control Unit for the purpose of investigation, civil action, or criminal action. Nothing contained herein shall prohibit the Department of Human Services from investigating or additionally referring to other proper law enforcement agencies cases of suspected Medicaid fraud, or the Attorney General from pursuing cases of suspected Medicaid fraud without a referral from the Department of Human Services if there is credible evidence of fraud.(b) (1) The Attorney General shall have all the powers necessary to comply with and enforce federal laws and regulations relative to the operation of the Medicaid Fraud Control Unit, including: the power to investigate cases of patient abuse or neglect; the power to investigate pursuant to chapter 15 of this title, claims of abuse or neglect of patients in healthcare facilities receiving payments under the territorial Medicaid plan; the power to issue or cause to be issued subpoenas or other process in aid of investigations, criminal prosecutions, and civil actions; the power to administer oaths and take sworn statements under penalty of perjury; and the power to serve and execute, in any part of the Territory, search warrants that relate to investigations authorized by this chapter.(2) Subpoenas ad testificandum or duces tecum issued pursuant to this chapter may be served by the Attorney General, any peace officer, or any competent person over 18 years of age. A refusal to obey such subpoena, or willful failure to appear, be sworn, testify, or produce records at the place and time specified, shall constitute contempt and shall be enforced by the Superior Court of the Virgin Islands as if it was a contempt of that Court. This subsection does not affect the inherent contempt power of any court.(3) (A) The Attorney General shall have authority to collect all fines, penalties, amounts of restitution, and interest accruing on any amount of restitution to be made and any penalties to be paid from and after default of any payment levied pursuant to the provisions of this chapter, or any other charge, cause of action, pre-litigation settlement or other settlement that recovers money wrongfully paid by the Department of Human Services on a claim submitted to the Department of Human Services under the Virgin Islands Medicaid Program.(B) Funds recovered by the Attorney General pursuant to this section must be deposited as follows:(i) Any restitution recovered and interest thereon must be apportioned between the federal government and the Virgin Islands Medical Assistance Program pursuant to applicable federal regulations.(ii) Any funds recovered for costs of investigation, litigation, attorney fees, and other expenses incurred by the Office of the Attorney General in enforcing this chapter must be allocated according to federal guidelines.(iii) The balance in the Medicaid Fraud Revolving Fund must not exceed an amount equal to 50% of the current-year’s budget for operating costs of the Medicaid Fraud Control Unit. Any funds exceeding that amount must be deposited into the General Fund.(c) The Medicaid Fraud Control Unit shall establish and maintain a website and phone messaging system to accept calls reporting suspected Medicaid fraud or suspicion of abuse or neglect of patients in facilities receiving Medicaid funding.(d) A potential Medicaid recipient is not eligible for benefits unless the recipient has authorized, in writing, the Virgin Islands Department of Human Services and the Attorney General to examine all records maintained, as required by the Virgin Islands Medicaid Program, of the recipient, or of those receiving or having received Medicaid benefits through the recipient, regardless of whether the receipt of such benefits would be allowed by the Virgin Islands Medicaid Program.(e) Each application to participate as a provider in the Virgin Islands Medicaid Program, each report stating income or expense upon which rates of payment are or may be based, and each invoice for payment for a good or a service provided to a recipient must contain a statement that all matters stated therein are true and accurate, signed by the provider or the provider’s agent. Any person who signs this statement or causes another to sign this statement knowing the statement to be false is guilty of perjury. For purposes of this subsection, an individual who signs on behalf of a provider is presumed to have the authorization of the provider and to be acting at the provider’s direction.
(a) The Department of Human Services or its fiscal agents shall refer all cases of suspected Medicaid fraud to the Medicaid Fraud Control Unit for the purpose of investigation, civil action, or criminal action. Nothing contained herein shall prohibit the Department of Human Services from investigating or additionally referring to other proper law enforcement agencies cases of suspected Medicaid fraud, or the Attorney General from pursuing cases of suspected Medicaid fraud without a referral from the Department of Human Services if there is credible evidence of fraud.
(b) (1) The Attorney General shall have all the powers necessary to comply with and enforce federal laws and regulations relative to the operation of the Medicaid Fraud Control Unit, including: the power to investigate cases of patient abuse or neglect; the power to investigate pursuant to chapter 15 of this title, claims of abuse or neglect of patients in healthcare facilities receiving payments under the territorial Medicaid plan; the power to issue or cause to be issued subpoenas or other process in aid of investigations, criminal prosecutions, and civil actions; the power to administer oaths and take sworn statements under penalty of perjury; and the power to serve and execute, in any part of the Territory, search warrants that relate to investigations authorized by this chapter.(2) Subpoenas ad testificandum or duces tecum issued pursuant to this chapter may be served by the Attorney General, any peace officer, or any competent person over 18 years of age. A refusal to obey such subpoena, or willful failure to appear, be sworn, testify, or produce records at the place and time specified, shall constitute contempt and shall be enforced by the Superior Court of the Virgin Islands as if it was a contempt of that Court. This subsection does not affect the inherent contempt power of any court.(3) (A) The Attorney General shall have authority to collect all fines, penalties, amounts of restitution, and interest accruing on any amount of restitution to be made and any penalties to be paid from and after default of any payment levied pursuant to the provisions of this chapter, or any other charge, cause of action, pre-litigation settlement or other settlement that recovers money wrongfully paid by the Department of Human Services on a claim submitted to the Department of Human Services under the Virgin Islands Medicaid Program.(B) Funds recovered by the Attorney General pursuant to this section must be deposited as follows:(i) Any restitution recovered and interest thereon must be apportioned between the federal government and the Virgin Islands Medical Assistance Program pursuant to applicable federal regulations.(ii) Any funds recovered for costs of investigation, litigation, attorney fees, and other expenses incurred by the Office of the Attorney General in enforcing this chapter must be allocated according to federal guidelines.(iii) The balance in the Medicaid Fraud Revolving Fund must not exceed an amount equal to 50% of the current-year’s budget for operating costs of the Medicaid Fraud Control Unit. Any funds exceeding that amount must be deposited into the General Fund.
(1) The Attorney General shall have all the powers necessary to comply with and enforce federal laws and regulations relative to the operation of the Medicaid Fraud Control Unit, including: the power to investigate cases of patient abuse or neglect; the power to investigate pursuant to chapter 15 of this title, claims of abuse or neglect of patients in healthcare facilities receiving payments under the territorial Medicaid plan; the power to issue or cause to be issued subpoenas or other process in aid of investigations, criminal prosecutions, and civil actions; the power to administer oaths and take sworn statements under penalty of perjury; and the power to serve and execute, in any part of the Territory, search warrants that relate to investigations authorized by this chapter.
(2) Subpoenas ad testificandum or duces tecum issued pursuant to this chapter may be served by the Attorney General, any peace officer, or any competent person over 18 years of age. A refusal to obey such subpoena, or willful failure to appear, be sworn, testify, or produce records at the place and time specified, shall constitute contempt and shall be enforced by the Superior Court of the Virgin Islands as if it was a contempt of that Court. This subsection does not affect the inherent contempt power of any court.
(3) (A) The Attorney General shall have authority to collect all fines, penalties, amounts of restitution, and interest accruing on any amount of restitution to be made and any penalties to be paid from and after default of any payment levied pursuant to the provisions of this chapter, or any other charge, cause of action, pre-litigation settlement or other settlement that recovers money wrongfully paid by the Department of Human Services on a claim submitted to the Department of Human Services under the Virgin Islands Medicaid Program.(B) Funds recovered by the Attorney General pursuant to this section must be deposited as follows:(i) Any restitution recovered and interest thereon must be apportioned between the federal government and the Virgin Islands Medical Assistance Program pursuant to applicable federal regulations.(ii) Any funds recovered for costs of investigation, litigation, attorney fees, and other expenses incurred by the Office of the Attorney General in enforcing this chapter must be allocated according to federal guidelines.(iii) The balance in the Medicaid Fraud Revolving Fund must not exceed an amount equal to 50% of the current-year’s budget for operating costs of the Medicaid Fraud Control Unit. Any funds exceeding that amount must be deposited into the General Fund.
(A) The Attorney General shall have authority to collect all fines, penalties, amounts of restitution, and interest accruing on any amount of restitution to be made and any penalties to be paid from and after default of any payment levied pursuant to the provisions of this chapter, or any other charge, cause of action, pre-litigation settlement or other settlement that recovers money wrongfully paid by the Department of Human Services on a claim submitted to the Department of Human Services under the Virgin Islands Medicaid Program.
(B) Funds recovered by the Attorney General pursuant to this section must be deposited as follows:(i) Any restitution recovered and interest thereon must be apportioned between the federal government and the Virgin Islands Medical Assistance Program pursuant to applicable federal regulations.(ii) Any funds recovered for costs of investigation, litigation, attorney fees, and other expenses incurred by the Office of the Attorney General in enforcing this chapter must be allocated according to federal guidelines.(iii) The balance in the Medicaid Fraud Revolving Fund must not exceed an amount equal to 50% of the current-year’s budget for operating costs of the Medicaid Fraud Control Unit. Any funds exceeding that amount must be deposited into the General Fund.
(i) Any restitution recovered and interest thereon must be apportioned between the federal government and the Virgin Islands Medical Assistance Program pursuant to applicable federal regulations.
(ii) Any funds recovered for costs of investigation, litigation, attorney fees, and other expenses incurred by the Office of the Attorney General in enforcing this chapter must be allocated according to federal guidelines.
(iii) The balance in the Medicaid Fraud Revolving Fund must not exceed an amount equal to 50% of the current-year’s budget for operating costs of the Medicaid Fraud Control Unit. Any funds exceeding that amount must be deposited into the General Fund.
(c) The Medicaid Fraud Control Unit shall establish and maintain a website and phone messaging system to accept calls reporting suspected Medicaid fraud or suspicion of abuse or neglect of patients in facilities receiving Medicaid funding.
(d) A potential Medicaid recipient is not eligible for benefits unless the recipient has authorized, in writing, the Virgin Islands Department of Human Services and the Attorney General to examine all records maintained, as required by the Virgin Islands Medicaid Program, of the recipient, or of those receiving or having received Medicaid benefits through the recipient, regardless of whether the receipt of such benefits would be allowed by the Virgin Islands Medicaid Program.
(e) Each application to participate as a provider in the Virgin Islands Medicaid Program, each report stating income or expense upon which rates of payment are or may be based, and each invoice for payment for a good or a service provided to a recipient must contain a statement that all matters stated therein are true and accurate, signed by the provider or the provider’s agent. Any person who signs this statement or causes another to sign this statement knowing the statement to be false is guilty of perjury. For purposes of this subsection, an individual who signs on behalf of a provider is presumed to have the authorization of the provider and to be acting at the provider’s direction.