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CEO of Planned Parenthood Accused of Medicaid Fraud Retires

by Steven Ertelt | Houston, TX | LifeNews.com | 11/4/11 11:38 AM

State

The head of the Texas-based Planned Parenthood abortion business facing accusations of massive Medicaid fraud related to billing for abortions and birth control retired this past weekend. On Saturday the president of Planned Parenthood flew to Houston to participate in a swanky gala for retiring Planned Parenthood Gulf Coast CEO Peter Durkin.

As LifeNews.com reported yesterday, a former employee of Planned Parenthood Gulf Coast has filed a whistleblower’s complaint with the Attorney General of Texas and the U.S. Department of Justice. The PPGC employee alleges that the abortion business engaged in an elaborate Medicaid fraud scheme.

According to a report on the Culture Map website, Cecile Richards, president of the Planned Parenthood Federation of America and daughter of the late former Texas Gov. Ann Richards, flew into Houston from New York to participate in a farewell bash for Durkin. Houston Mayor Annise Parker issued a proclamation declaring the day as Peter J. Durkin Day in Houston and the event featured a presentation by pro-abortion U.S. Rep. Sheila Jackson Lee.

Durkin will eventually retire in April, but pro-life blogger Jill Stanek, who first noted the whistleblower lawsuit related to the Medicaid fraud, says he has numerous questions to answer now.

“After 26 years as CEO of Planned Parenthood Gulf Coast, Peter Durkin has announced he will retire in April 2012,” she said. “The timing works out well for Durkin to avoid publicly having to deal with a complaint filed by former PPGC employee Karen Reynolds alleging massive Medicaid fraud.”

“Reynolds lodged her complaint in July 2009, but it was under seal until this past March and is only just starting to get traction. On October 18 Judge Ron Clark denied PPGC’s request to stop the discovery process, which is now underway according to American Center for Law and Justice attorney Frank Manion, with whom I spoke,” Stanek continued. “In addition, Reynolds saved emails and memos substantiating her allegations, which she submitted as part of her complaint to both the U.S. and Texas Attorneys General.”

Stanek says the Planned Parenthood abortion business may suffer irreparable damages if it if found guilty of fraud.

“If PPGC is found guilty of fraud against the government, it will be wiped out.  Its 2010 IRS Form 990 indicates 2/3 of its service revenue comes from state and federal taxpayers,” she explains. “PPGC’s corporate offices are housed in the United States’ largest abortion clinic, located in Houston.

Stanek also noted that one of the witnesses listed in the lawsuit is Abby Johnson, the former Planned Parenthood abortion facility director in Bryan, Texas who is now pro-life, but her attorneys indicated she can’t comment publicly on any relevant knowledge she may have about an ongoing legal matter.

The complaint alleges Planned Parenthood Gulf Coast had a policy of providing abortions and medical services based on the ability of customers to pay — similar to the sliding scale policies of most Planned Parenthood abortion businesses. The complaint says patients were paying out of pocket, then only “services based on medical necessity” were provided. However, if patients were relying on Medicaid or another government program to pay the Planned Parenthood bill, then planned Parenthood would run up the costs “often provid[ing] services on an ‘across the board’ basis even when such services were not medically necessary.”

Reynolds, in her complaint, also noted that Planned Parenthood officials would frequently give women on Medicaid requesting birth control a bag of condoms and vaginal film, even if they had not requested them, to run up the tab the federal government would pay with taxpayer funds.

The fraud was allegedly not limited to birth control and contraception, the former employee said in her complaint. Reynolds alleges that Planned Parenthood Gulf Coast would falsify medical charts for patients having or who had had abortions to make it appear as if their visit was primarily for some other reason so Planned Parenthood would receive federal reimbursement. As Stanek notes:

The biggest bombshell in the complaint comes on page 15, which describes how PPGC falsified charts of aborting or post-abortive patients to appear as if their visit was for another reason. It is illegal under the Hyde Amendment for federal taxpayer dollars to fund abortions unless for rape, incest, or life of the mother. But PPGC found ways around this. Quoting from one PPGC memo listed in the complaint:

POST AB VISITS:
We must work these clients in! This visit is self-pay. Quote the self-pay price then ask if she needs any other services such as birth control. If she is interested, screen for WHP or Title XX and offer the WWE [Well Woman Exam]. If the client is getting on birth control make this the focus of the visit and put a note in the chief complaints that the client had a surgical or medical abortion “x” weeks ago.

To pro-lifers, this information is the proverbial smoking gun, showing more than that the line of demarcation between federal funds and abortion is fungible, but that at least this Planned Parenthood worked the system to illegally obtain taxpayer dollars for abortion-related services.

Stanek indicates “PPGC’s bilking scheme was elaborate and, frankly, fascinating. It allegedly involved several corporate officers, including {PPGC CEO Peter] Durkin as well as board members, clinic directors, assistant clinic directors, health care assistants, and nurse practitioners.”

“According to the complaint, each clinic was given annual, monthly, and daily government revenue goals. In conjunction, monthly staff meetings that included PowerPoint presentations were held at all clinics to train how to maximize government revenue. PPGC went so far as to send employees from “under-performing” clinics to “higher-performing” clinics to learn how to increase revenue, which included double-billing,” she continued.

In his investigation of Planned Parenthood in Congress, a letter Rep. Cliff Stearns, a Florida Republican who is the chairman of the House Committee on Oversight and Investigations, wrote to Planned Parenthood president Cecile Richards requests any information related to improper billing related to federally-funded programs, proof that federal funds are not being improperly used to pay for abortions by PPFA or its affiliates, audits by state agencies of any Planned Parenthood affiliate, and documentation of how many affiliates currently receive Title X family planning funding.

The Stearns letter also requests documents on standards and practices related to billing issues, written policies and procedures, and it requests information on how the abortion giant keeps its family planning abortion monies separate and segregated.

Planned Parenthood has been found to have engaged in fraudulent billing or faces accusations of such improper billing in multiple states:

California – A 2004 audit found that Planned Parenthood of San Diego and Riverside Counties overcharged the government $5,213,645.92 for oral contraceptives. The problem was that Planned Parenthood was supposed to charge the government the cost of the pills. Instead, it charged a much higher price.

New York – A 2008 federal audit of state family planning claims resulted in a finding that the state of New York had overbilled the federal government $17,151,156 by claiming procedures as “family planning” services when they were not. The federal audit report noted that, “Officials at Planned Parenthood providers stated that they believed that nearly all the services they provide are related to family planning. However, the medical review determined that the providers improperly claimed, for example, services to pregnant women, treatment for sexually transmitted diseases, and counseling visits unrelated to family planning services.”

New Jersey – In 2008, the federal government conducted an audit of New Jersey and published a report, Review of Outpatient Medicaid Claims Billed as Family Planning by New Jersey, which showed the state had overcharged the federal government $597,496.00. In a section entitled “Causes of Overpayment,” the report states: “During our visits to family planning clinics throughout the State, many providers (especially Planned Parenthood providers) stated that they billed all claims to Medicaid as “family planning.” Officials at these clinics stated that they believed that all of the services they provided were related to family planning. Therefore, officials at these clinics often populated the family planning indicator field on Medicaid claims even though the service provided did not meet the criteria for 90-percent Federal funding. By populating this field, the MMIS designated the claim as eligible for 90-percent Federal funding.”

Washington – A 2009 audit found Planned Parenthood of the Inland Northwest overcharged the government $629,142.88. The audit found Planned Parenthood was charging excessive amounts for contraceptives and distributed and charged for prescription medication without having a valid prescription.

New York City – A 2009 Medicaid audit determined that Planned Parenthood’s Margaret Sanger Center in New York City was found to have overcharged Medicaid $1,254,603.00 which included double billing—billing Medicaid for services provided to patients who were enrolled in the provider’s HMO network.