(a) (1) It is unlawful for any provider willfully and knowingly to:(A) Make or cause to be made a claim, knowing the claim to be false, in whole or in part, whether by commission or omission;(B) Make or cause to be made a claim, statement, or representation for use in obtaining or seeking to obtain authorization to provide goods or services, knowing the claim, statement or representation to be false in whole or in part, whether by commission or omission;(C) Make or cause to be made a claim, statement, or representation for use by another in obtaining goods or services under the Virgin Islands Medicaid Program, knowing the claim, statement, or representation to be false, in whole or in part, whether by commission or omission;(D) Make or cause to be made a statement or representation for use in qualifying as a provider of goods or services under the Virgin Islands Medicaid Program knowing the statement or representation to be false in whole or in part, whether by commission or omission;(E) Charge any recipient, or provider acting on behalf of a recipient, money or other consideration in addition to or in excess of rates of remuneration established under the Virgin Islands Medicaid Program; or(F) Solicit or accept a benefit, pecuniary benefit, or kickback in connection with goods or services paid or claimed by a provider to be payable by the Virgin Islands Medicaid Program.(2) (A) For the purposes of this section, a provider is deemed to have known that a claim, statement, or representation was false if the provider knew, or by virtue of the provider’s position, authority or responsibility, had reason to know of the falsity of the claim, statement or representation.(B) For the purposes of this section, a provider is deemed to have made, or caused to be made, a claim, statement, or representation if the provider:(i) had the authority or responsibility to make the claim, statement, or representation; supervised the person who made the claim, statement, or representation; or authorize the making of the claim, statement, or representation, whether by operation of law, business or professional practice, or office procedure; and(ii) exercised such authority or responsibility or failed to exercise such authority or responsibility, and as a direct or indirect result, the false statement was made.(3) Penalties(A) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received is less than $100, is guilty of a misdemeanor, pursuant to 14 V.I.C. § 834;(B) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received $100 or more, is guilty of a felony, pursuant to 14 V.I.C. § 834;(C) Any provider who receives payment for furnishing goods or services under the Virgin Islands Medicaid Program which the person is not entitled to receive by reason of commission of any actions delineated in paragraph (1) of this subsection, in addition to any other penalties provided by law, is liable for:(i) Full restitution to the Virgin Islands Department of Human Services of all funds or payments received in violation this chapter;(ii) Payment of interest on the amount of the payment, at the maximum legal rate in effect on the date the payment was made for the period from the date upon which payment was made to the date upon which the repayment is made to the Department of Human Services; and(iii) The costs of investigation and litigation and attorney fees.
(1) It is unlawful for any provider willfully and knowingly to:(A) Make or cause to be made a claim, knowing the claim to be false, in whole or in part, whether by commission or omission;(B) Make or cause to be made a claim, statement, or representation for use in obtaining or seeking to obtain authorization to provide goods or services, knowing the claim, statement or representation to be false in whole or in part, whether by commission or omission;(C) Make or cause to be made a claim, statement, or representation for use by another in obtaining goods or services under the Virgin Islands Medicaid Program, knowing the claim, statement, or representation to be false, in whole or in part, whether by commission or omission;(D) Make or cause to be made a statement or representation for use in qualifying as a provider of goods or services under the Virgin Islands Medicaid Program knowing the statement or representation to be false in whole or in part, whether by commission or omission;(E) Charge any recipient, or provider acting on behalf of a recipient, money or other consideration in addition to or in excess of rates of remuneration established under the Virgin Islands Medicaid Program; or(F) Solicit or accept a benefit, pecuniary benefit, or kickback in connection with goods or services paid or claimed by a provider to be payable by the Virgin Islands Medicaid Program.
(A) Make or cause to be made a claim, knowing the claim to be false, in whole or in part, whether by commission or omission;
(B) Make or cause to be made a claim, statement, or representation for use in obtaining or seeking to obtain authorization to provide goods or services, knowing the claim, statement or representation to be false in whole or in part, whether by commission or omission;
(C) Make or cause to be made a claim, statement, or representation for use by another in obtaining goods or services under the Virgin Islands Medicaid Program, knowing the claim, statement, or representation to be false, in whole or in part, whether by commission or omission;
(D) Make or cause to be made a statement or representation for use in qualifying as a provider of goods or services under the Virgin Islands Medicaid Program knowing the statement or representation to be false in whole or in part, whether by commission or omission;
(E) Charge any recipient, or provider acting on behalf of a recipient, money or other consideration in addition to or in excess of rates of remuneration established under the Virgin Islands Medicaid Program; or
(F) Solicit or accept a benefit, pecuniary benefit, or kickback in connection with goods or services paid or claimed by a provider to be payable by the Virgin Islands Medicaid Program.
(2) (A) For the purposes of this section, a provider is deemed to have known that a claim, statement, or representation was false if the provider knew, or by virtue of the provider’s position, authority or responsibility, had reason to know of the falsity of the claim, statement or representation.(B) For the purposes of this section, a provider is deemed to have made, or caused to be made, a claim, statement, or representation if the provider:(i) had the authority or responsibility to make the claim, statement, or representation; supervised the person who made the claim, statement, or representation; or authorize the making of the claim, statement, or representation, whether by operation of law, business or professional practice, or office procedure; and(ii) exercised such authority or responsibility or failed to exercise such authority or responsibility, and as a direct or indirect result, the false statement was made.
(A) For the purposes of this section, a provider is deemed to have known that a claim, statement, or representation was false if the provider knew, or by virtue of the provider’s position, authority or responsibility, had reason to know of the falsity of the claim, statement or representation.
(B) For the purposes of this section, a provider is deemed to have made, or caused to be made, a claim, statement, or representation if the provider:(i) had the authority or responsibility to make the claim, statement, or representation; supervised the person who made the claim, statement, or representation; or authorize the making of the claim, statement, or representation, whether by operation of law, business or professional practice, or office procedure; and(ii) exercised such authority or responsibility or failed to exercise such authority or responsibility, and as a direct or indirect result, the false statement was made.
(i) had the authority or responsibility to make the claim, statement, or representation; supervised the person who made the claim, statement, or representation; or authorize the making of the claim, statement, or representation, whether by operation of law, business or professional practice, or office procedure; and
(ii) exercised such authority or responsibility or failed to exercise such authority or responsibility, and as a direct or indirect result, the false statement was made.
(3) Penalties(A) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received is less than $100, is guilty of a misdemeanor, pursuant to 14 V.I.C. § 834;(B) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received $100 or more, is guilty of a felony, pursuant to 14 V.I.C. § 834;(C) Any provider who receives payment for furnishing goods or services under the Virgin Islands Medicaid Program which the person is not entitled to receive by reason of commission of any actions delineated in paragraph (1) of this subsection, in addition to any other penalties provided by law, is liable for:(i) Full restitution to the Virgin Islands Department of Human Services of all funds or payments received in violation this chapter;(ii) Payment of interest on the amount of the payment, at the maximum legal rate in effect on the date the payment was made for the period from the date upon which payment was made to the date upon which the repayment is made to the Department of Human Services; and(iii) The costs of investigation and litigation and attorney fees.
(A) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received is less than $100, is guilty of a misdemeanor, pursuant to 14 V.I.C. § 834;
(B) Any provider committing any actions delineated in paragraph (1) of this subsection where the aggregate amount of payments illegally claimed or received $100 or more, is guilty of a felony, pursuant to 14 V.I.C. § 834;
(C) Any provider who receives payment for furnishing goods or services under the Virgin Islands Medicaid Program which the person is not entitled to receive by reason of commission of any actions delineated in paragraph (1) of this subsection, in addition to any other penalties provided by law, is liable for:(i) Full restitution to the Virgin Islands Department of Human Services of all funds or payments received in violation this chapter;(ii) Payment of interest on the amount of the payment, at the maximum legal rate in effect on the date the payment was made for the period from the date upon which payment was made to the date upon which the repayment is made to the Department of Human Services; and(iii) The costs of investigation and litigation and attorney fees.
(i) Full restitution to the Virgin Islands Department of Human Services of all funds or payments received in violation this chapter;
(ii) Payment of interest on the amount of the payment, at the maximum legal rate in effect on the date the payment was made for the period from the date upon which payment was made to the date upon which the repayment is made to the Department of Human Services; and
(iii) The costs of investigation and litigation and attorney fees.
(b) (1) It is unlawful for a person to:(A) Obtain or attempt to obtain, or aid, abet or assist any individual to obtain, assistance to which an applicant is not entitled or assistance greater than that to which an applicant is justly entitled by means of a false statement or representation, or by false impersonation, or by a fictitious transfer, conveyance or encumbrance of property or income, or by a knowing and willful failure to report to the Virgin Islands Department of Human Services income, personal property, real property, household members, or other material eligibility factors at the time of application or during the receipt of assistance, or by other fraudulent device; or(B) Knowingly obtain, aid, abet or assist any individual to obtain or attempt to obtain assistance to which the individual is not entitled by sale, barter, purchase, theft, acquisition, possession or use of any medical identification card or any other device authorizing participation in the Virgin Islands Medicaid Program.(2) Penalties.(A) If the acts in either subsection (b)(1)(A) or (b)(1)(B) of this section cause the Virgin Islands Department of Human Services to determine that an individual or family is eligible for benefits under the Virgin Islands Medicaid Program, and the aggregate amount of assistance paid on behalf of the individual or individuals is less than $5,000, the offense, upon conviction, shall be a misdemeanor punishable by a fine of up to $500 or imprisonment for up to three months, or both a fine and imprisonment. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.(B) If the acts in paragraph (1)(A) or (1)(B) of this subsection cause the Virgin Islands Department of Human Services to determine an individual or family eligible for benefits under the Virgin Islands Medicaid Program and the aggregate amount of assistance paid on behalf of the individual or individuals is equal to or greater than $5,000, the offense, upon conviction, shall be a felony punishable by fine of up to 5,000 or imprisonment of not more than five years, or both. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.
(1) It is unlawful for a person to:(A) Obtain or attempt to obtain, or aid, abet or assist any individual to obtain, assistance to which an applicant is not entitled or assistance greater than that to which an applicant is justly entitled by means of a false statement or representation, or by false impersonation, or by a fictitious transfer, conveyance or encumbrance of property or income, or by a knowing and willful failure to report to the Virgin Islands Department of Human Services income, personal property, real property, household members, or other material eligibility factors at the time of application or during the receipt of assistance, or by other fraudulent device; or(B) Knowingly obtain, aid, abet or assist any individual to obtain or attempt to obtain assistance to which the individual is not entitled by sale, barter, purchase, theft, acquisition, possession or use of any medical identification card or any other device authorizing participation in the Virgin Islands Medicaid Program.
(A) Obtain or attempt to obtain, or aid, abet or assist any individual to obtain, assistance to which an applicant is not entitled or assistance greater than that to which an applicant is justly entitled by means of a false statement or representation, or by false impersonation, or by a fictitious transfer, conveyance or encumbrance of property or income, or by a knowing and willful failure to report to the Virgin Islands Department of Human Services income, personal property, real property, household members, or other material eligibility factors at the time of application or during the receipt of assistance, or by other fraudulent device; or
(B) Knowingly obtain, aid, abet or assist any individual to obtain or attempt to obtain assistance to which the individual is not entitled by sale, barter, purchase, theft, acquisition, possession or use of any medical identification card or any other device authorizing participation in the Virgin Islands Medicaid Program.
(2) Penalties.(A) If the acts in either subsection (b)(1)(A) or (b)(1)(B) of this section cause the Virgin Islands Department of Human Services to determine that an individual or family is eligible for benefits under the Virgin Islands Medicaid Program, and the aggregate amount of assistance paid on behalf of the individual or individuals is less than $5,000, the offense, upon conviction, shall be a misdemeanor punishable by a fine of up to $500 or imprisonment for up to three months, or both a fine and imprisonment. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.(B) If the acts in paragraph (1)(A) or (1)(B) of this subsection cause the Virgin Islands Department of Human Services to determine an individual or family eligible for benefits under the Virgin Islands Medicaid Program and the aggregate amount of assistance paid on behalf of the individual or individuals is equal to or greater than $5,000, the offense, upon conviction, shall be a felony punishable by fine of up to 5,000 or imprisonment of not more than five years, or both. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.
(A) If the acts in either subsection (b)(1)(A) or (b)(1)(B) of this section cause the Virgin Islands Department of Human Services to determine that an individual or family is eligible for benefits under the Virgin Islands Medicaid Program, and the aggregate amount of assistance paid on behalf of the individual or individuals is less than $5,000, the offense, upon conviction, shall be a misdemeanor punishable by a fine of up to $500 or imprisonment for up to three months, or both a fine and imprisonment. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.
(B) If the acts in paragraph (1)(A) or (1)(B) of this subsection cause the Virgin Islands Department of Human Services to determine an individual or family eligible for benefits under the Virgin Islands Medicaid Program and the aggregate amount of assistance paid on behalf of the individual or individuals is equal to or greater than $5,000, the offense, upon conviction, shall be a felony punishable by fine of up to 5,000 or imprisonment of not more than five years, or both. Additionally, the court may exercise its discretion by imposing an administrative sanction regarding future Medicaid benefits.
(c) As used in this section:“Administrative sanction” means the entry of an order making an individual who violates a provision of this section ineligible for Medicaid assistance for a specified period. Such order shall be served upon the Virgin Islands Department of Human Services.
“Administrative sanction” means the entry of an order making an individual who violates a provision of this section ineligible for Medicaid assistance for a specified period. Such order shall be served upon the Virgin Islands Department of Human Services.
(d) In addition to the penalties provided by this chapter, the Department of Human Services may, upon the conviction of any provider wherein Medicaid fraud on the provider’s part is involved, suspend the provider agreement between the Department of Human Services and the provider and suspend reimbursement to the provider for goods or services claimed for a period of up to one year from the date of final adjudication of the matter.