Government Watchdog Credited with Making the Medicaid Fraud Case

Alexander Farrelly Criminal Justice Complex (File photo)
The Alexander Farrelly Criminal Justice Complex on St. Thomas. (File photo by Shaun Pennington)

A probe into government corruption led to fraud charges against Everton Garvey, an eligibility specialist for the Virgin Islands Medicaid program. Garvey was charged with manipulating the system, and made an initial appearance in court on Friday along with Nicholas Peru, an investigator from the Office of the Virgin Islands Inspector General.

Charges brought against Garvey resulted from a joint investigation between the Inspector General’s office, the Department of Health and Human Services, and the Medicaid Fraud Control Unit.

The arrest warrant came from the Inspector General, a relatively rare instance where a review of government agency functions led to criminal charges.

A five-page affidavit filed by Peru details a probe that began with an unidentified individual telling authorities that someone in the Medicaid office was “giving his friend Medicaid.” The document, filed in Superior Court, says the notice came to the attention of an administrator at the Department of Human Services in June.

That alert led to questions posed to the defendant and an individual identified by the letters JJ. According to court documents, an application to receive Medicaid benefits – allegedly from JJ – was uncovered when the manager examined the computer program used for that purpose.

“After reviewing the case file for JJ, the assistant director found that JJ was not eligible for any Medicaid benefits,” the affidavit said. That determination, based on an apparent discrepancy between the household salary reported by JJ and the salary entered into the processing system.

A computerized records check also led to identification of Garvey’s handwriting in the application file. The defendant was questioned twice about processing the document and advised of his rights afterwards. JJ, also questioned by investigators, said they never applied for Medicaid benefits.

Garvey – a Medicaid eligibility specialist – is charged with conversion of government property, filing fraudulent claims on the government, forgery and embezzlement. It was the second time since January that an employee of the V.I. Medicaid system was accused of breaking the law. In January, authorities charged Medicaid program supervisor Kathleen Gussie.

Superior Court Magistrate Henry Carr III set bail for Garvey at $10,000 and allowed for his release upon posting 10 percent in cash or property. Carr also ordered the defendant to appear at an arraignment hearing on Oct. 15.

The magistrate also barred Garvey from accessing the Virgin Islands Eligibility and Benefits Enrollment System, the computer program used to process Medicaid applications.