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Hope Dialysis Center says it’s not being paid for Medicaid services

Hope Dialysis treatment room
Medicaid says it sounds like “a problem on their side”

Pago Pago, AMERICAN SAMOA — According to a media release from the Hope Dialysis Center (HDC), dated Mar. 28, 2022, the dialysis center has not been paid for Medicaid services in over 7 months and points to a requirement of the Center for Medicare & Medicaid Services (CMS), who regulates local payments through the federal program, that Medicare and Medicaid are to pay healthcare providers within 30 days of claims submission.

HDC says that it is owed over $200,000 and is in debt to all of its creditors and is in financial hardship as a result of lack of payment.

It notes, “both Medicaid and the ASG Treasury have been contacted multiple times but refuse to give any reasons why Hope Dialysis Center is not being paid.”

 “It’s not possible to run a business without being paid for service in a timely manner.” Chris Fisher from HDC stated.

“Sandra King at the Medicaid office was helpful in allowing us to participate in the local Medicaid program as we were seeing many patients for free.

“Now the Treasury has our documentation for payment, and we have no idea why they can’t pay us.

“Many patients don’t have Medicare and none have private insurance, so we need Medicaid reimbursement to operate,” he said.

Fisher points out in the HDC media release that “the 2-year lockdown has harmed Hope Dialysis Center’s business as well.

“More than 30 dialysis patients are stranded off island and cannot return.

Samoa News reached out via email to the local director of Medicaid, Tofoitaufa Sandra King Young, for comment about HDC’s statement of non-payment for Medicaid services.

In her official email reply, dated Mar. 28, she notes that according to their records, “Medicaid has paid to HDC since July 2021: $532,534.98. We only have an outstanding balance: $110,546.25.”

Tofoitaufa explains, “There was a period of delay for payments due to HDC failing to properly do the certification to pay.

“Medicaid will only issue reimbursement payments only after ALL documentation and justification have been submitted, signed and verified” — the 30-day HDC mentions is “if they have what we call clean claims.  But if not — if they don't submit the correct paperwork — it resets that clock for payment.

“Medicaid does not have to pay unless all the proof for allowable reimbursement has been submitted and validated.

“Providers must comply with our rules to claim proper reimbursements no matter how long it takes,” she said.

According to the local Medicaid director, “that may be what Chris Fisher is referring to about not being paid for however many months — was actually a problem on their side.

“We work closely with their staff to help them get their paperwork in order. Medicaid always has issues with HD certifications as their worksheets for reimbursements submitted by their office often do not add up to what is reported on the Remittance Advice from Noridian, the Medicare contractor.

“Nevertheless, we should be issuing their outstanding balance of $110,546.25 this week as my staff has informed me their paperwork is now in order,” she concluded.

Tofoitaufa added that “Medicaid brought HDC under the Disaster Relief SPA to provide dialysis services to passengers coming in during the repatriation flights and all other HDC patients have benefited from that.”

However, “once the Public Health Emergency (PHE) declaration ends on April 16, Medicaid will cease coverage of patients at HDC 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. HDC was not a Medicaid provider before the pandemic and their eligibility is temporary during the PHE,” she explained.

The HDC media release also refers to a LBJ hospital policy concerning their patients as part of its explanation of the set of negative issues the center is currently facing.

It notes that “LBJ had a policy that was enforced by staff that any Hope Dialysis Center patient that went to LBJ for unrelated treatment were told they had to transfer to LBJ dialysis or they would not be seen.

“Hope Dialysis Center has patient statements that verify this.

“We’re hoping the new LBJ CEO and Board of Directors work with us and change LBJ policies for the sake of the patients.” said Fisher.

 “Our intent in opening a private dialysis center in American Samoa, was to provide the same level of treatment expected in the United States.

We have achieved that with an amazing staff and we’ve created 20 high paying jobs,” Fisher stated.

 He goes on to spotlight LBJ dialysis service, which he says “has over 200 patients.

“It was reported by ESRD Network 17 that LBJ dialysis center’s death rate was 47% higher than average.

“Hope Dialysis Center currently has 40 patients and has facilitated all the repatriated dialysis patients.”

Fisher reports that HDC’s “patients have not had one emergency room visit from dialysis treatment in the over 2 years they have been open.

“Dr. Letarte is the only board certified nephrologist in American Samoa and sees every patient daily, Monday through Friday,” he notes.

 Fisher goes on to state in the media release, “Hope Dialysis Centers management has spoken to the Health Committee, DOC, senators, the LT governor and the media, but has received no support from ASG.

He says, “If ASG wants to promote an improved economy, higher wages, private healthcare for better treatment options and a healthier population, they should support the success of Hope Dialysis Center and all private business by helping in any way they can for the people.”

The media release also highlights HDC management’s plans “to build a new dialysis center in the future to facilitate more patients and a new surgical center with US board certified cardiologists, vascular surgeons, and other specialists coming in every two weeks to eliminate the need for Medicaid referrals to Hawaii.”

According to Fisher, “This would save Medicare and Medicaid millions of dollars and allow the local population to have immediate access to US specialist M.D.s on island.

“It will also open the door for other private healthcare facilities to open for better patient care,” Fisher stated.

He concludes saying, “The only way to accomplish this [HDC’s plans] would be to meet with the Governor and his administration and hear our plan of action and work together to improve healthcare for everyone.”

HDC’s media release comes at a time when LBJ is going through a management upheaval as its board of directors, under the chairmanship of Dr. Malouamaua Tuiolosega, is determined to “promote LBJ to where it should rightly be.” He points to the summation of the governor’s vision and their transformation of the same into priorities of policies for LBJ to pursue. One of the priorities is to “recruit native, local, and qualified Doctors, Nurses, and Healthcare Specialists” which is counter to HDC’s move to have US board certified specialists come in every two weeks.