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Texas Planned Parenthood Abortion Biz Must Repay $1.4 Million After Medicaid Fraud

by Steven Ertelt | Austin, TX | LifeNews.com | 7/24/13 1:26 PM

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The Planned Parenthood abortion business must repay $1.4 million dollars in Texas after it was found to have participated in a massive Medicaid fraud scheme.

Last year, 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.

Karen Reynolds, who worked as a “health care assistant” from 1999 to 2009 at the Lufkin, Texas, branch of the affiliate formerly known as Planned Parenthood of Houston and Southeast Texas, submitted company memos and emails to support her charge that PPGC has engaged in a systemwide scheme to bilk Medicaid, Title XX, and the Women’s Health Program of tens of millions of dollars over the course of at least a decade.

Reynolds alleges bosses trained employees to bill government agencies for medical and family planning services not rendered, for services no reasonable medical personnel would provide, and – the biggest bombshell – for abortion-related services fudged to appear as if they were not.

Today, the Texas Attorney General’s Office concluded the State’s Medicaid fraud investigation into Planned Parenthood Gulf Coast, Inc. Under today’s agreement, Planned Parenthood Gulf Coast must pay $1.4 million for fraudulently overbilling the taxpayer-funded Medicaid program Texas Attorney General Greg Abbott announced.

From Abbott’s office:

After a whistleblower lawsuit was filed alleging improper billing practices by Planned Parenthood Gulf Coast, an investigation was opened by the Texas Attorney General’s Office and the Texas Health and Human Services Commission’s Office of Inspector General. The State’s investigation revealed that Planned Parenthood Gulf Coast improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and were not covered by the Medicaid program – and were therefore not eligible for reimbursement. For example, state investigators determined that Planned Parenthood Gulf Coast falsified material information in patients’ medical records in order to support fraudulent reimbursement claims to the Medicaid program.

Under the agreement announced today, Planned Parenthood Gulf Coast must pay $1.4 million to resolve the Medicaid fraud enforcement action. Because Medicaid is jointly funded by the State and the federal government, the federal government is entitled to a portion of the Texas recovery. Under the Texas Medicaid Fraud Prevention Act, the relator-whistleblower that uncovered the defendant’s fraudulent conduct will also receive a share of the State’s recovery.

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 foam, 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.

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.”

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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.