Planned Parenthood Accused of Massive Medicaid Fraud in Texas

National   |   Steven Ertelt   |   Nov 3, 2011   |   10:48AM   |   Houston, TX

The Planned Parenthood abortion business in yet another state is facing accusations of massive Medicaid fraud related to billing for abortions and birth control — at a time when Congress is launching an investigation.

According to pro-life blogger Jill Stanek, 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.

Stanek writes:

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, has 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.

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:

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.