The Hampton Roads clinics are pausing Medicaid services next month as the state suspended reimbursements amid investigation.
Thousands of Medicaid patients served by Fishing Point Healthcare in Hampton Roads are scrambling to find new providers because the clinics paused services as a state investigation for suspected fraud unfolds.
Associated with the Nansemond Tribe, Fishing Point has clinics in Newport News and Portsmouth. The entity has not received funding disbursed by the Virginia Department of Medical Assistance Services since April 2025.
When fraud is suspected involving federal funds, state agencies are required to impose payment suspensions. DMAS’ probe into the alleged fraud continues.
The matter made it into the public eye in recent weeks as Fishing Point published a notice on its website that it would suspend services to Medicaid patients on April 15 of this year.
At an Affordable Care Act anniversary event in Newport News on March 23, Fishing Point board member David Darling described providers’ and patients’ anxiety over the issue and framed the crisis as “what started off as administrative confusion.”
“I am struggling to sleep at night over what’s about to happen,” he added as he implored officials to reimburse Medicaid services.
“It seems to be a little bit of an issue between the office of DMAS and the attorney general,” Darling explained. “They’re both involved, and both of them are telling us, ‘we can’t do it.’ They have to.”
Virginia Health and Human Resources Secretary Marvin Figueroa, who’d been a panelist at the event, said he would take Darling’s card and check in on matters.
“It’s our responsibility as the state to be good stewards of the public office, and when it comes to situations where there may be credible evidence of fraud by federal regulation, we are required to pause payments investigation,” he said. “Our goal is always not to cut off services.”
The issue, which first arose during Janet Kelly’s tenure as Virginia Health and Human Resources Secretary and Jason Miyares’ tenure as Attorney General, has continued as Figueroa and Jay Jones have stepped into the roles.
Darling did not respond to follow-up questions after the event. Calls to the Nansemond tribe and Fishing Point’s clinics also went unanswered this week.
Fishing Point CEO Lance Johnson explained to The Virginian-Pilot that the organization has continued billing “in hopes that we can get this squared away and get reimbursed for the care that we’re providing while the fraud investigation is going on.”
“We’re at a point right now where we can’t continue to afford to do that,” he added.
What went awry?
A March 27 statement from DMAS said that after suspending Fishing Point’s payments on April 29, the state engaged in outreach to Medicaid Fee-For-Service members and directed Medicaid managed care organizations to do the same, to prevent care gaps.
“Phone calls were made to ask if the Medicaid members had any unmet care needs or had a need to find a healthcare provider for any reason,” the statement said.
The department has continued to monitor submission of reimbursement claims for services weekly in order to spot changes or drops in claims so that it can be proactive in helping coordinate care changes if needed, the statement added.
DMAS also said it was not notified by Fishing Point that it intended to stop treating Medicaid patients, the statement continued. Since becoming aware, it has taken immediate action to reach out to people to alert them and recommend other care options.
DMAS explained that it first noticed a significant billing increase over a short period of time as well as “unusual billing patterns by Fishing Point” in early 2024.
From July 2023 to June 30, 2024 the clinics billed DMAS for $105 million for 1,267 Medicaid members it served.
The bulk of that bill, $96 million, was for personal care services — medical supplies for at-home care that helps elderly people or those with disabilities with daily necessities like bathing or eating.
A letter from DMAS to Fishing Point last year notifying them of the suspension also pointed to billing in excess of five encounters per day for a single Medicaid member for clinic and pharmacy services.
Other allegations of fraud included billing for personal care services on the same dates as inpatient hospital stays for the associated Medicaid member, inflated hours per day of billing for personal care services, and billing for some Medicaid members where “there is no evidence of an established relationship with a tribal clinic provider.”
After launching an investigation, DMAS concluded that there were five “credible allegations of fraud.”
