Nansemond Indian Nation says Virginia is withholding Medicaid funding in new lawsuit
By Ryan Murphy/WHRO
The Nansemond Indian Nation is accusing the state of Virginia of undermining its sovereign rights and violating federal law by refusing to pay out $1.7 million in Medicaid claims.
The tribe alleges in a new federal lawsuit that state agencies and officials are trying to shift the blame for Virginia's financial mistakes and coerce Fishing Point Healthcare, a clinic operated by the tribe, into a new structure to compete less with other private providers.
'Rather than partnering with a federally recognized Tribal Nation to improve health-care access for low-income families and stabilize Virginia's own faltering healthcare infrastructure, Virginia officials have instead weaponized the Commonwealth's administrative machinery to punish a Tribal Health Program that dared to step into the breach,' reads the lawsuit, which was filed Tuesday.
The filing says Virginia appears to have thought Fishing Point would only be serving tribal members. The suit says state agencies likely claimed an incorrect amount for Medicaid payments for non-Native American patients than allowed, 'thereby creating a substantial risk that the federal government would reclaim millions of dollars from' the state.
The tribe says the state argued after the fact that some of the services Fishing Point was providing were not authorized for Medicaid reimbursement 'so they could shift any repayment obligation' onto the Nansemond.
The state also pushed the tribe to rework its clinic structure, away from the federally-recognized Tribal Health Program and to a model similar to private companies contracted with the state. The tribe argues the state's pressure was intended to limit Fishing Point's competition with other private providers.
The filing alleges the state has refused to pay out any Medicaid reimbursements for some services since October, and as of March 31stall of Fishing Point's Medicaid claims were frozen – a total of 7,650 worth about $1.7 million – 'thereby weaponizing the billing process to coerce Plaintiffs into capitulating to Defendants' demands.'
Efforts to reach Virginia's Department of Medical Assistance Services, which manages Medicaid in the state and is named as one of the defendants in the filing, received no response Wednesday.
Fishing Point says it's continuing to provide care to both tribal members and non-Native American patients, but the funding freeze 'represents a financial chokehold that threatens to cripple Fishing Point's ability to sustain operations,' according to the lawsuit.
The Suffolk-based tribe started Fishing Point Healthcare in 2023, five years after it was federally recognized. Federal recognition allows tribal nations to provide health care to its members and serve anyone using federal healthcare assistance like Medicaid.
The system started with a clinic in Portsmouth and Fishing point just opened its second clinic in Newport News. Fishing Point CEO Lance Johnson told WHRO earlier this year the health system has plans for expansion to other cities over the next few years, including a Norfolk clinic already in the works.
This story was originally published by WHRO Public Media, the Hampton Roads region's largest media company.
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