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Abortion Practitioner Arrested for Medicaid Fraud in Georgia

by Steven Ertelt | Atlanta, GA | LifeNews.com | 12/20/11 2:01 PM

State

An Atlanta, Georgia-based abortion practitioner has been arrested as he faces accusations of accepting hundreds of thousands of dollars in Medicaid payments that were fraudulent.

Tyrone Malloy and his abortion facility office manager were arrested, according to a spokesman for the office of the Georgia Attorney General. As WSBTV reports, Malloy and office manager CathyAnn Warner reportedly took in more than $380,000 in payments for pre-abortion ultrasounds Malloy never did and abortions that did not qualify for reimbursement under Medicaid.

Malloy and Warner were indicted by a grand jury on two counts of Medicaid fraud and, if they are convicted, they face 10 years in prison and a $10,000 fine. After his arrest, Malloy posted bond.

Federal rules allow for Medicaid funding for abortions only if they are done in the very rare cases such as saving the life of the mother or rape or incest.

Malloy runs the Old National Gynecology abortion business in College Park, but the television station indicates he received the Medicaid payments at another DeKalb County office. State officials received a tip from Georgia’s Department of Community Health, which runs the Medicaid program in Georgia, about the fraud.

WSBTV sent a reporter to the abortion facility for an on-camera interview but no one answered the door even though employees peered through blinds at the reporters. An hour later, employees at the abortion facility appeared to get in their vehicles and left the premises. Attempts to reach Malloy and Warner by phone also produced no results.

Medicaid fraud has been a longstanding problem in the abortion industry.

The ACLJ has filed a federal lawsuit representing Karen Reynolds, a former Health Center Assistant at the Planned Parenthood Gulf Coast (PPGC), in Lufkin, Texas. This is another whistleblower case. And, once again – Planned Parenthood (PP) faces serious charges involving fraud – overbilling – the misuse of millions of dollars in taxpayer funds.

According to the complaint, during her decade-long employment at this clinic, Reynolds learned that PPGC knowingly engaged in continued violations of both federal and state law by adopting and implementing company-wide billing policies intended to maximize revenue received from government health care programs (such as Medicaid and Title XX) by expressly requiring PPGC’s clinics in Texas and Louisiana to bill the federal and state governments for reimbursement for (i) medical services that were never actually rendered; (ii) medical services that, although rendered, were known by Defendant to be medically unnecessary; and (iii) abortion-related services that PPGC knew were not properly reimbursable through these government programs.

Planned Parenthood has already been found to have overcharged state and federal governments in five states.

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.”

In 2010, the New York Times released a new report showing Planned Parenthood Golden Gate in California faces an audit from the criminal division of the Internal Revenue Service. The report detailed how an unnamed former employee interviewed with the Oakland field office of the IRS in response to a complaint he lodged with the governmental agency.

The employee, who would not let the Times name him for fear of his future job prospects, said he filed a two-part complaint about the abortion business’ problematic relationship with its political arm and about financial problems at the abortion business.

The overbilling problems also extend to Planned Parenthood centers in New Jersey.

The U.S. Inspector General for the Department of Health and Human Services uncovered a consistent problem with New Jersey-based family planning clinics run by the Planned Parenthood abortion business. They were found to be improperly billing Medicaid for services that did not qualify as family planning.

New Jersey authorities were sent letters in July 2007, June 2008 and August 2008 notifying them of the problems and requesting action to correct the errors. The reports found billing errors from February 1, 2001 through January 31, 2005.

An initial audit revealed New Jersey improperly received federal reimbursement at the enhanced 90% rate for 160,955 prescription drug claims that were billed as family planning, but did not qualify as family planning services. A letter from the Inspector General to New Jersey officials recommended that New Jersey repay $2,219,746 to the federal government.

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.”

The state eventually returned $2.9 million to the federal government.

In Washington state, 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.

Also, pro-life advocates say they believe Planned Parenthood in Iowa is overbilling the state for “bilking insurance companies out of grossly inflated fees.”

Operation Rescue revealed Planned Parenthood is charging insurance companies $1,000 for the drug-induced abortion process even though the overhead costs for the abortion are lower with the abortion practitioner off site via telemed abortions

This overbilling effectively drives up the cost of health insurance for everyone, its president, Troy Newman, contends.

“Planned Parenthood of the Heartland is making a killing on medical abortions,” he said. “Planned Parenthood is gouging insurance companies twice the price of their cash abortions. That’s how they can afford to keep their smaller clinics running.”

“And if taxpayers are forced to fund these abortions, there’s no telling how much they will charge, because government funding is a blank check,” he added.

Meanwhile, also in 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.

Jim Sedlak, the director of Stopp Planned Parenthood, a watchdog group, has said the overbilling and fraud is enough to cause Congress to cancel any Planned Parenthood funding.

“Millions of dollars in overbilling and the federal government wants to keep giving Planned Parenthood our money,” he said. “The states have to repay millions of dollars to the federal government because Planned Parenthood wrongly claims that nearly all its services are “family planning” when they are not, yet the federal government is threatening to punish the states for cutting off funds to Planned Parenthood.”