Nansemond Clinic’s Medicaid Network Stalls in Hampton Roads

Fishing Point Healthcare paused Virginia Medicaid care on April 15, 2026, cutting off more than 4,400 patients after a year without state payments. The Nansemond Indian Nation’s Hampton Roads clinics kept seeing Native patients under a federal contract, and told everyone else to find a new doctor.

The halt landed 21 months after Mayor Shannon Glover helped open the Portsmouth flagship, and it followed a dismissed federal lawsuit, a frozen Medicaid pipeline, and a billing year the state put at $105 million.

A One-Stop Shop on London Boulevard

The clinic at 2929 London Blvd. took its first patients on February 12, 2024, in a former orthopedic building the tribe turned into a medical home. Board chairman David “Black Feather” Darling said the aim was a stop where a person could see a doctor, fill a prescription, sit for labs, and get an X-ray without a second trip across town.

Glover cut the ribbon at the Portsmouth grand opening on London Boulevard on July 19, 2024, and talked about a stronger, healthier, more inclusive city. Darling’s line that day was the mission the tribe had put on paper: “Our mission is to be a guiding beacon of health where compassion, empathy and expertise converge.”

Only three exam rooms were live at first. Darling said the build-out would reach 18 rooms once dentistry, physical therapy, lab, and radiology came online in the second phase, which the nation timed to that July ceremony. Hours were posted weekdays, 8 a.m. to 5 p.m., at 757-861-9010.

WHAT THE PORTSMOUTH CLINIC PUT UNDER ONE ROOF

• Primary care: The first service line, aimed at Medicaid enrollees and members of federally recognized tribes.
• On-site pharmacy: Scripts filled in the same building as the exam rooms.
• Dental, lab, radiology, physical therapy: Added in the 2024 second phase so patients were not sent out for basics.
• Home health, behavioral health, recovery: Run as a regional network, including a 20-bed substance-use facility and a separate behavioral site in Chesapeake.

The English name was not a marketing flourish. Nansemond means fishing point, and the nation, about 450 citizens at the time of the opening, had founded Fishing Point Healthcare in 2023 after years of in-home care that Darling said generated the cash to lease brick-and-mortar space.

Federal Recognition Brought an $801 Visit Rate

Congress put the Nansemond on the list of federally recognized tribes on January 29, 2018, through the Thomasina E. Jordan Indian Tribes of Virginia Federal Recognition Act, alongside five other Virginia nations. That status opened Indian Health Service contracting under the Indian Self-Determination and Education Assistance Act, the law clinics in this trade call a 638 agreement.

Fishing Point Health Care LLC shows as active in the federal NPI registry from February 6, 2023, doing business as the Nansemond Indian Nation. Darling told local audiences that as an extension of the federal government, the clinic “enjoy[s] a different rate than a private provider would.” For calendar 2025, IHS published an outpatient per visit rate of $801 in the Lower 48, with a $5,580 inpatient per diem; Medicare’s outpatient figure was $718.

That encounter rate is paid per visit, not per stitch of work inside the visit, and federal matching is not the same for every patient. A court later recited the split Virginia uses: the federal government covers 100 percent of Medicaid for American Indian and Alaska Native patients treated at a tribal clinic, and 50.99 percent for everyone else. Fishing Point still billed the tribal encounter methodology for the mixed panel it recruited, which is the legal hinge the whole fight turned on.

CEO Lance Johnson would later put it in one sentence: “It’s a simple following federal regulations. That’s really what this is about.”

How $105 Million Landed on 1,267 Members

DMAS, Virginia’s Medicaid agency, says it first noticed a sharp rise in Fishing Point billing and unusual patterns in early 2024. For the fiscal year from July 2023 through June 30, 2024, the agency says the clinics billed $105 million for 1,267 Medicaid members, $96 million of it for personal care, the in-home help with bathing, dressing, and meals that is not a typical primary-care line.

A new general-practice LLC that registered in February 2023 and then stacked most of its Medicaid volume on attendant-care codes is not the billing shape of a neighborhood exam-room practice. Personal care can be real and still dominate a ledger when a 638 clinic leans into home health, which is what Fishing Point did before the Portsmouth rooms opened, and the state’s later freeze treated that mix as a fraud risk rather than a service mix.

TWO DIFFERENT COUNTS ON THE SAME LEDGER

Those two patient counts are not a contradiction. The 1,267 figure is the state’s billed-member tally for one fiscal year; the March 2026 letter is the clinic’s own headcount of Virginia Medicaid enrollees it could no longer afford to see. In a court filing, DMAS deputy director Jeffrey Lunardi wrote that Virginia had already paid the provider more than $190 million, a cumulative paid total, not the $105 million billed in that single fiscal year.

Virginia Called It Fraud and Stopped the Checks

The tribe says Virginia stopped paying some personal-care claims in October 2024 and, around March 31, 2025, parked 7,650 claims worth about $1.7 million in pending status. On April 29, 2025, DMAS imposed a full payment freeze on Fishing Point and its pharmacies.

A DMAS memo issued as the pause approached said the freeze was required under federal rules once the agency found a credible allegation of fraud, and that it had looked for “good cause” to keep money flowing and found none. Patterns cited in that period included personal-care billing on dates when the member was in a hospital, hours of home care the agency called inflated, more than five encounters in a day for clinic and pharmacy services, and members with no clear tie to a tribal clinic provider.

Johnson said the examples the state had shown him were “a very low percentage, in fact less than 1% of the billed amount,” and that if an employee or contractor had billed wrong, the clinic would repay it. Fishing Point’s later written position was that DMAS had drawn the wrong federal match on tribal claims and, in the administrative hearing, had acknowledged owing the federal government between $100 million and $200 million; that account comes from the clinic, not from a public DMAS admission on the same point.

FROM RECOGNITION TO THE MEDICAID PAUSE

1. January 29, 2018: The Nansemond Indian Nation receives federal recognition.
2. February 6, 2023: Fishing Point Health Care LLC is active in the NPI registry; the nation founds the health arm the same year.
3. February 12, 2024: The Portsmouth clinic begins seeing patients at 2929 London Blvd.
4. July 19, 2024: Glover and Darling officiate the grand opening of the expanded site.
5. March 1, 2025: A second clinic opens in Newport News, first in temporary space, with a 17,000-square-foot Jefferson Avenue build planned in phases.
6. April 1, 2025: The nation and Fishing Point sue Virginia in federal court.
7. April 29, 2025: DMAS suspends Medicaid payments after a fraud referral.
8. August 8, 2025: U.S. District Judge Rebecca Beach Smith dismisses the suit.
9. March 15, 2026: Fishing Point writes Medicaid patients that care will stop on April 15.
10. April 15, 2026: Virginia Medicaid services pause; Native patients remain under the 638 contract.

Newport News Mayor Philip Jones warned that downtown seniors who used the community pharmacy would feel the cut. A planned Norfolk clinic, on a Church Street building the group had bought, never opened. Johnson tied that stall directly to the missing payments.

The Lawsuit Ended in August 2025

Nansemond Indian Nation v. Commonwealth of Virginia, No. 2:25-cv-00195, named Gov. Glenn Youngkin, DMAS, and other state officials and asked a Norfolk federal judge to restart the money. Tribal counsel Greg Werkheiser called the pending-claims freeze an attempt to penalize or bankrupt the nation before the case could be heard. A request for an emergency restraining order was denied on April 8, 2025.

The complaint argued Virginia was protecting managed-care companies, underpaying the tribal rate, and pushing Fishing Point toward a private-provider model that would erase the 638 advantage. Werkheiser said a November 2024 federal audit had shown the state withholding pay the clinic was owed.

Smith granted the state’s motion to dismiss on August 8, 2025 (795 F.Supp.3d 733). The Eastern District of Virginia case file shows the preliminary-injunction request mooted, clerk’s judgment entered the same day, and the civil action closed. Virginia Lawyers Weekly’s recap of the 67-page opinion is blunt: each claim failed as a matter of law, and the clinic would have to use the state’s administrative appeal track. DMAS later said Fishing Point lost the informal appeal and had a formal appeal pending.

WHERE THE TWO SIDES STILL DISAGREE

• DMAS: Federal rules required a full freeze once a credible allegation of fraud existed, members can be placed with other Medicaid plans, and “no Medicaid member is losing access to care.”
• Fishing Point: The freeze misreads 638 billing, the dollar examples are a sliver of claims, and Virginia, not the clinic, pulled the wrong federal match.
• Johnson on the standstill: He said he would work with investigators, including on employee-level errors, but that the probe had dragged on nearly a year with the doors still starved of Medicaid cash.

No criminal charges have been announced. The Medicaid Fraud Control Unit’s work was still described as active after the clinics paused.

Who Lost Care When Medicaid Stopped

On March 15, 2026, Fishing Point’s management team posted a letter pausing all services for Virginia Medicaid enrollees effective April 15, “due to nonpayment of claims by Virginia’s Department of Medical Assistance Services (DMAS) for nearly one year.” The letter said the clinic could not stay open to “you and our more than 4,400 other Virginia Medicaid patients.”

We are saddened to report that we are pausing all services for Virginia Medicaid enrollees effective April 15, 2026, due to nonpayment of claims by Virginia’s Department of Medical Assistance Services (DMAS) for nearly one year. Without payment from DMAS, we are unable to stay open to you and our more than 4,400 other Virginia Medicaid patients.

Fishing Point Healthcare Management Team, March 15, 2026 patient letter

After that date, staff would handle only emergencies, no new scripts, no kept appointments. Records went to the patient portal, with paper copies from records@fishingpointhc.com. The letter pointed people to Cover VA at 1-833-522-5582 and to local legislators, and closed, “We look forward to reopening our doors to you.”

Marc Gibson, a Chesapeake patient with heart disease who had started at the Portsmouth clinic the previous fall, said his physical therapist told him his level of care meant he had to go elsewhere. He had been driving 35 to 40 minutes, twice a week, because the place did not feel rushed.

The level of care I’ve received has been unbelievable. I would hope everyone gets this level of care from their doctor. That’s why I’m willing to drive 35, 40 minutes twice a week to go there.

Marc Gibson, Fishing Point patient, Chesapeake

DMAS told members to call 804-786-6145 if they were in fee-for-service, or to call one of the five Medicaid managed care organizations if they already had a plan, with Maximus at 1-800-643-2273 as a backup switchboard. Other community clinics in the region said they were still taking people. That is a network on paper. It is not the doctor who already had Gibson’s file.

Native Patients Stay as the Appeal Drags

Johnson said care would continue for Native patients on Medicaid because the 638 contract requires it. Non-Native Medicaid patients, the bulk of the 4,400, were the ones sent out. That split is the inverse of the 2024 talking point, when Darling and Johnson sold the clinics as a high-quality door for underserved people, Native or not.

WHAT WE KNOW

• The pause date: Virginia Medicaid services stopped on April 15, 2026, per the clinic letter and DMAS’s member page.
• The freeze date: DMAS halted payments on April 29, 2025, and said a formal administrative appeal was still underway after an informal loss.
• The court result: The federal case was dismissed on August 8, 2025, and closed the same day.

WHAT IS UNCONFIRMED

• A fraud finding: The probe is described as active; no public finding of liability and no criminal charge have been issued.
• A reopen date: Johnson said the doors would open again if the money moved; neither the clinic site nor the DMAS member page has posted a restart.
• Norfolk: The Church Street clinic and 2026 outpatient-surgery talk did not become a working site once the freeze hit.

The London Boulevard building is still listed on Fishing Point’s site, with the March 15 letter sitting on top of the appointment copy. For the patients who used that address as a one-stop shop, the reckoning is already practical: a new plan, a new pharmacy, and a chart that no longer lives at 2929 London Blvd.

Disclaimer: This article is news reporting on a clinic opening, a Medicaid payment freeze, and a closed federal case, and it is for information only. It is not medical advice, not legal advice, and not a guide to Medicaid eligibility, billing, or whether any claim is fraudulent. Readers who need care, coverage, or counsel should speak with a licensed clinician, a Medicaid caseworker or managed-care plan, or a qualified attorney before changing providers or acting on billing disputes. Dollar figures, case statuses, and clinic hours come from the agency memos, court docket, clinic letter, and federal rate notice cited above and can change as the formal appeal and fraud probe move.