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Report fraud or abuse Program Integrity investigates activities related to preventing, detecting, and investigating allegations of fraud or abuse by Medicaid providers and beneficiaries. Every dollar lost due to the misuse of Medicaid benefits is one dollar less available to fund programs that provide essential medical services to vulnerable Virgin Islanders. If we do not work together to help stop fraud and abuse, the system may not be available to those the program was created to help. You can contact the Division of Medicaid Program Integrity Division in several ways as outlined below, including by phone, postal mail, email, and online forms. It is advisable not to send forms by email or submit online forms containing protected health information or personally identifiable information to protect confidentiality in accordance with the Health Insurance Portability and Accountability Act of 1996. FILL OUT ONLINE COMPLAINT FORM Click Here • Phone: 340-715-6998 • Email: medicaidfraud@dhs.vi.gov • Mailing Address: ATTN: Office of Program Integrity 1303 Hospital Ground St. Thomas, V.I. 00802 Types of fraud and abuse by health care providers Medicaid Providers (e.g. doctor, dentist, counselor, etc.) should be referred to the Office of Program Integrity for any suspicion of abuse or fraud such as: • Billing for services not rendered • Billing for services where medical necessity is not established • Upcoding or inappropriate billing that results in a loss to the Medicaid program. • Inadequate or missing documentation to support billed services • Quality of care issues that do not meet professionally accepted health care standards. • Falsification of medical necessity certificates, treatment plans and medical records to justify payment. • Soliciting or receiving bribes • Violation of Medicaid policies, procedures, rules, regulations and/or statutes Types of Fraud and Abuse of Beneficiaries Medicaid recipients should be referred to the Office of Program Integrity for review if there are suspicions about: • Excessive or Overuse of Medicaid • Using Another Person's Medicaid ID Card • Loaning, Modifying, or Duplicating a Medicaid ID • Providing incorrect eligibility or false information to a health care provider to obtain treatment • Receiving benefits simultaneously in USVI and another state • Knowingly Assisting Service Providers in Providing Services to Defraud the Medicaid Program • Prescription fraud Thank you for your support in fulfilling our mission, ensuring that Medicaid funds are used to provide quality medical coverage to those who are eligible to receive services.