A physician based in Doral, Florida is suing the V.I. Department of Human Services for what he says is a “multi-year failure” to reimburse him for Medicaid services provided to USVI patients.
In a pro se lawsuit filed in District Court in late July, Naim Dahdah says that he has been providing care to USVI Medicaid beneficiaries since at least 2019. Before 2022, however, Dr. Dahdah claims that he was denied access to the VIMMIS billing platform, because DHS failed to onboard him as a provider “despite Plaintiff's repeated requests via phone, email, and physical documentation.”
The lack of portal access meant that hundreds of legitimate claims went unsubmitted, unrecorded, and thus unpaid – at least $900,000 worth, according to the lawsuit.
Once he was able to access the billing portal, from 2023 onwards, Dr. Dahdah says he began submitting valid Medicaid claims. Since then, he has submitted over $800,000 in claims but has received less than $200,000 in reimbursement. The internal medicine practitioner says a further $60,000 has been acknowledged, but had yet to be disbursed. According to the lawsuit, DHS has cited “new vendor registration requirements” for the delay.
“Plaintiff complied with all requests, including GVIBuy registration, and still has not received payment,” the complaint states.
Dr. Dahdah says the lawsuit comes after all previous attempts at outreach to rectify the situation have failed. He cites multiple complaints to the Region 2 Medicaid office, the Medicaid Fraud Control Unit of the V.I. Department of Justice, and the offices of the Governor and Lieutenant Governor, none of which has garnered any response from DHS officials, according to the lawsuit. Neither has a complaint submitted to the Agency for Health Care Administration in Florida, or a notice of intent to sue sent last month. “These efforts received no adjudication, no guidance, and no substantive response,” the lawsuit alleges.
Apart from the Department itself, the director of the Medicaid program in the V.I., Gary Smith, and Medicaid Claims Supervisor Carla Huggins are named as defendants in Dr. Dahdah's suit, both in their official capacities. Mr. Smith has allegedly entirely failed to respond to Dr. Dahdah's queries and complaints, while Ms. Huggins has only provided “non-substantive” replies, the lawsuit claims.
As a result of this alleged intransigence from DHS, Dr. Dahdah's “reputation and credit have been damaged by continuous unpaid labor, late IRS obligations, rising credit card debt, and damage to public credibility within the hospital system,” according to the civil complaint. Dr. Dahdah also says business plans have had to be placed on hold due to the lack of cashflow caused by the pile-up of unpaid claims. This has led to “missed production and launch timelines for these businesses, estimated to have multi-million dollar potential.”
The damage has been compounded because he “has been routinely assigned USVI Medicaid patients others refused to treat due to payment problems,” the lawsuit alleges, hinting at broader issues within the system.
Dr. Dahdah is accusing the VIDHS of breach of contract, due process violations, unjust enrichment, gross administrative negligence or misconduct, fraud by suppression and misrepresentation, and bad faith conduct by a government entity. He asks the court to find that DHS is legally obligated to pay all outstanding claims, and to process pending reimbursements in a timely manner. He is also seeking “permanent injunctive relief to compel timely Medicaid claim processing,” punitive damages, as well as at least $10 million in compensatory damages.
As of press time, there has not yet been a response to the lawsuit from DHS.
