Pago Pago, AMERICAN SAMOA — Dr. Malouamaua Tuiolosega in response to the recent Samoa News article titled ‘More Than $300,000 in LBJ Hospital Board allowances raises legal questions’, says the American Samoa Medical Center Authority (ASMCA) and LBJ Hospital’s semi-autonomous status were created to stop the misuse of Federal funds that were being diverted into the ASG General Fund instead of reaching LBJ Hospital.

During that time, ASG failed to pay stateside hospitals that treated LBJ-referred patients, and many medical suppliers and pharmaceutical companies also went unpaid — even though Centers for Medicare and Medicaid Services (CMS) had already provided the funding. These funds were absorbed into the General Fund rather than being used for patient care.

As a result, the U.S. Department of the Interior withheld further funds until ASG created a semi- autonomous authority to properly manage LBJ finances. This requirement led to the establishment of the ASMCA.

The ASMCA was formally created by Executive Order 017-1993 on June 2, 1993, following EO 010-1993, which established a governing Board. The Board, consisting of five members, is mandated to oversee operations and is allocated an annual operating budget.

The 2023 Board Operations Budget approved by the Legislature:

•  General administrative supplies: $78,000

•. Board stipends, contractual services, legal services: $60,000

•. Conferences and training (Pacific Nations & U.S. States): $150,000

•  Public relations (Employee Appreciation Weeks): $249,500

Comments:

The leaked ledger clip lists only total payments to payees and does not provide itemized details such as stipends, allowances, reimbursements, travel costs, accommodations, transportation, membership fees, per-diems, or meals.

(For transparency: Dr. Tuiolosega says LBJ still owes him reimbursement for equipment, safety gear, and tools he personally purchased for the two newly hired electricians — who arrived with no tools, wearing flip-flops, and using a screwdriver to operate high-voltage breakers.)

Accomplishments Dr. Tuiolosega’s lists during his tenure as Board Chair:

MGC / Project Pasifika

1. Launched Project Pasifika on March 16, 2023.

2. Established a working partnership with HRP Consultants, resulting in over $2.1 million recovered from CMS after correcting prior cost-report submission errors.

3. Recruited 34 nurses, all NCLEX-RN certified.

4. Presented the new LBJ Employee Handbook and Code of Conduct.

5. Developed LBJ’s CMS OIG-Required Compliance Plan.

6. Created and implemented LBJ’s Communication Plan.

7. With Currie & Brown, developed and presented LBJ’s Procurement Standards, Policies, and Procedures.

8. Oversaw on-site MGC staff improvements in coding, billing, patient receivables, third- party audits, and CMS OIG Charge-Master development.

9. Submitted the CMS LBJ ESRD Clinic Revalidation and continued monitoring its pending status.

10. Completed the LBJ Rural Acute Care Hospital Revalidation.

11. Enrolled all clinicians in NPI and CMS PECOS, enabling CMS-billable services and supporting the recruitment of high-salary specialists (neurology, dermatology, cardiology, etc.).

12. Enrolled new LBJ Clinic Groups for Part B professional billing revenues.

13. Improved CMS–ASG Medicaid CPE calculations, resulting in $800K for FY 2019 above the original submission.

14. Developed LBJ’s first Strategic Plan.

15. Completed MGC’s Clinical Needs Assessment and Comprehensive Care Model.

16. Developed and installed the ER Whiteboard system to improve patient flow and tracking.

17. Identified significant pharmacy cost savings.

18. Researched and confirmed that LBJ employee housing costs are Medicare and Medicaid allowable expenses.

19. Collaborated with Copeland Clinical (U.K.) on multiple site visits to assess critical clinical improvements, patient accommodation planning, and ER workflow redesign.

20. Provided research demonstrating why the proposed $200M Lion’s Park Specialty Hospital was not feasible due to CMS reimbursement limitations, duplicative services, and insufficient professional staffing.

21. Recommended a coordinated model using two U.S.-based radiologists to meet CMS requirements for radiology oversight.

22. Filed Certificates of Need for new service lines and equipment additions.

23. Recommended new medical technologies across cardiology, radiology, and pathology.

24. Created foundational structures—including the LBJ Foundation, Articles of Incorporation, and Bylaws—to expand LBJ services into durable medical equipment, home health care, and an LBJ Medicare Advantage Plan, which could generate $10–$20 million annually for chronic-care patients (~10,000 residents).

25. Implemented salary increases.

26. ...and much more.

“There is still much work ahead, and I hope these efforts will continue. However, my term on the Board has concluded,” he said.