Mugshot of Kathleen Gussie By. THE VIRGIN ISLANDS POLICE DEPARTMENT
Kathleen Gussie, a former supervisor of the Medicaid eligibility section of the Department of Human Services' Medicaid Program Certification Unit, was arrested on Thursday morning on fraud and embezzlement charges, announced V.I. Attorney General Denise George during a virtual press conference Thursday afternoon.
Gussie was arrested for allegedly fraudulently using and obtaining medicaid funds for her own benefit while she was not lawfully eligible for such benefits. D.H.S.'s Medicaid Program Certification Unit determines the eligibility of persons in the community for Medicaid benefits.
According to the Affidavit, Guisse filed under the income threshold of $31,931.00 when she was making $44,103. This income level would make Guisse ineligible for Medicaid benefits.
"Medicaid benefit claims were submitted for payment by medical providers for services provided to Guisse from December 11, 2017 up until July 3, 2018," states the affidavit. "The document also showed that she was making more than the $31,931.00 during this time."
In one instance, Gussie on Dec. 11, 2017, showed up to the Juan F. Luis Hospital's emergency room for medical attention, according to the affidavit, seen here. It states that as part of the admission process, Gussie was interviewed to determine whether a Hospital Presumptive Eligibility for Medicaid (HPE) was required. "At the time, Gussie should have known that her salary as an eligibility supervisor exceeded the proposed income threshold for a family of four used by the D.H.S. to determine eligibility for Medicaid benefits," reads the affidavit. "Instead, Gussie was provided an HPE application which was subsequently filled out and submitted." The complaint states that as part of the HPE application, an entry to Gussie's family size and salary was provided.
According to Ms. George, after the matter was reported to Gussie's supervisors, she was placed on suspension "for quite some time." Her termination was approved by Governor Albert Bryan several months ago.
The Department of Justice charged her with two charges of embezzlement, fraudulent claims upon the government and conversion of government property.
Gussie has been released by paying 10 percent of her $50,000 bond.
This was the first arrest made by the new Medicaid Fraud Control Unit of the V.I. Department of Justice. Ms. George stated, “We expect there to be many more” as there are other ongoing investigations at the unit.
The newest unit of the D.O.J is responsible for the investigation and prosecution of Medicaid provider fraud, abuse and neglect of persons in healthcare facilities, and Medicaid program fraud within the Department of Human Services.
The unit works closely with the Department of Health and Human Services and the Office of the Inspector General.
Kimberley Causey-Gomez, V.I. D.H.S commissioner, said, “As demonstrated by today’s events, the Department of Human Services under our team’s leadership will not tolerate fraud, waste, and abuse in any of our divisions, especially Medicaid.”
The Department of Justice set up an anonymous hotline, 1-888-404-6328, for individuals to bring any suspected cases of Medicaid fraud to their attention.
