Pago Pago, AMERICAN SAMOA — Hope Dialysis Center has announced it will be closing its’ doors next month. According to CEO Chris Fisher, it is because it can no longer operate without Medicaid reimbursement, which he says will stop after Apr. 16, 2022.

In the HDC press release, dated Apr. 5, 2022, Fisher explained, the center has struggled for over 2 years because of the Covid-19 lockdown.

“Without Medicaid reimbursement we cannot operate. We can stay open for another few weeks so our patients can go to LBJ or off island for treatment.

“Their new providers will be reimbursed by Medicaid.”

Fisher continues, “We are extremely disappointed that we couldn’t stay for the people of American Samoa, be we had many forces working against us.

“The pandemic kept our patients off island for most of 2020- 21.

“A dialysis center doesn’t profit until it has about 50 patients and gets 20% co-payments reimbursed.

“We know our highly skilled staff will all be welcome at LBJ or DOH.

“We hope our patients can find a better center for their dialysis,” he stated.

Fisher said in the HDC press release that “the only options left to keep HDC open would be to have legislation approved for Medicaid reimbursement after April 16.

“The other option is ASG could acquire HDC and use it as a dialysis facility for west side patients.

“Either would allow all patients and staff to remain.

“It’s up to ASG.

“We are willing to work with the government for the patients,” Fisher concluded.

LOCAL MEDICAID OFFICE RESPONSE TO CLOSURE

The director of the local Medicaid Office, Tofoitaufa Sandra King Young, responding to a request from Samoa News for comments concerning HDC closing due to Medicaid not paying reimbursements in a timely manner, reiterated what she had told Samoa News in a story reported in the Mar. 30, 2022 issue.

“Medicaid is current on their payments,” she stated, in her recent response to Samoa News, dated Apr. 7th. She continued, “ I warned them [HDC] from the very beginning when they were trying to set up, if they want to create a business here in AS, they need to be able to financially sustain themselves without expecting or relying on Medicaid because our government does not YET have the local match funds to sustain private providers.

“I do not know how long they have been in operation, but they only became a temporary Medicaid provider last year during the COVID public health emergency time period.

“How did they survive before Medicaid?” she asked.

Tofoitaufa explained that “the purpose of their [HDC] emergency enrollment was to provide dialysis services to the dialysis patients who were repatriating home during the repat flights and being quarantined upon arrival.

“We have LBJ who provides dialysis services and that meets the requirements for Medicaid to provide dialysis services in the territory.”

In an earlier Mar. 30 email to Samoa News, responding to Samoa News’ request for comment about HDC’s claim of non payment of Medicaid reimbursements, the head of the local Medicaid Office pointed out that “Medicaid brought HD[C] under the Disaster Relief SPA to provide dialysis services to passengers coming in during the repatriation flights and all other HD[C] patients have benefited from that.” (See Mar. 30, 2022 Samoa News news report.)

“Once the Public Health Emergency (PHE) declaration ends on April 16, Medicaid will cease coverage of patients at HD[C] and all other DRA SPA enrollees after April 16 — unless the President [Biden] extends the PHE.

“Medicaid is in the process of winding up services enabled during the COVID pandemic. HD[C] was not a Medicaid provider before the pandemic and their eligibility is temporary during the PHE,” the local Medicaid director said.

In her Apr. 7th email response to HDC closing its’ doors, Tofoitaufa states that HDC needs to “have a business sustainable plan on their own before they try to blame Medicaid for closing their doors.”

She said she has informed HDC that “their future eligibility is a policy decision that we must assess because it impacts the local match requirement. At the end of the PHE period, the local match returns to its regular match percentage of 45% local/ 55% federal. 

And, she noted, “Medicare is still available to them for reimbursements.”

Tofoitaufa added that “I will meet with the Governor next week to discuss options on whether to continue HDC services if we can carve out a local match. I think we would need several weeks to design the solution once we return to the old matching rate.”

HDC INTERNAL PROBLEMS

Samoa News has also received a copy of a HDC Board of Directors Resolution that indicates there is some ‘hostility’ between Fisher and the HDC board.

Dated Apr. 5 — co-incidentally the same date as the press release from Fisher — the document, titled, Resolution Temporarily Suspending Director From Board, says a special meeting of the HDC Board was held on Apr. 5, and present at the meeting were two voting members of the Board of Directors (BoD), constituting a quorum, comprising: Jean LeTarte and Johnson Masunu.

The resolution points to what the directors believe is “a pattern of malfeasance in his [Fisher] capacity as president and chairman,” as well as having “acquired information suggesting that Chris Fisher may have also misappropriated HDC funds for payment of personal expenses.”

 It says under these circumstances, to protect the best interests of the Corporation and its shareholders, the BoD has a duty to remove Fisher as president of the corporation and suspend him as a director of the corporation.

The resolution then resolves to remove Fisher as president of the corporation, suspends him as a director of the HDC Board, and terminates him as an employee of HDC for cause.

“RESOLVED FURTHER, that effective immediately, Mr. Fisher shall not receive any entitlement owed to him as President of HDC and Mr. Fisher shall be barred from HDC property/ will no longer have access to HDC bank or credit accounts, will no longer serve in a supervisory capacity of employees or otherwise participate in the activities of HDC as an employee.”

The resolution resolves to elect new officers and names the following as the new officers of the BoD: LeTarte — President; Masunu — Treasurer; and, John Wasko — Secretary.

The two voting members of the BoD present at the meeting, LeTarte and Masunu, signed the document.

In response, Fisher said that the directors are under Non Disclosure Agreements (NDAs) with HDC and should not be going to the ‘media’ about company issues, and that LeTarte and Masunu own only 22% shares of the company, while he owns 50% of the shares. He states, “I have to be notified 10 days in advance for all meetings. I can't be outvoted.”

Togiola Tulafono, who is also a sitting senator and a former governor of American Samoa, has become involved in the issue due to his being HDC’s lawyer and queried Tofoitaufa via email as to why she continues to “to deny payment of dialysis services provided by HDC to our Medicaid qualified local residents.”

Samoa News obtained a copy of the Togiola’s email in which he writes that “the government’s failure to take care of these charges can only mean that Medicaid and the government do not care about these patients and their health.”

 “Is there a real legitimate reason or excuse other than the government trying to put HDC out of business?” Togiola asks Tofoitaufa in his email.

In addition, a Tualauta faipule has also become involved. In an email to Tofoitaufa, the faipule asks Tofoitaufa for clarification about an email Fisher cc’d to him that was addressed to ‘Sandra King Medicaid Director American Samoa’. Fisher’s email was about the lack of payments to HDC for over 7 months.

In Tofoitaufa’s responses via emails (copies of which are in Samoa News possession) both to HDC’s lawyer and the Tualauta faipule, she explains the process the local Medicaid Office has taken to pay HDC’s reimbursements, and highlights some of the problems her office had with several of HDC invoices. She also repeats her explanation about HDC’s current “temporary” participation in the Medicaid program and that her office believes that their payments to HDC are current.

Samoa News will report later in the week on another issue that has come to light concerning HDC, which further endangers the dialysis center’s operations.