Whistleblower Says Planned Parenthood Defrauded Government

State   Steven Ertelt   Feb 14, 2012   |   7:02PM    Lufkin, TX

A former Planned Parenthood employee continues to make the case publicly that the abortion business had a routine policy defrauding government and is pressing a lawsuit against her former employer.

Karen Reynolds, a former Health Center Assistant at the Planned Parenthood Gulf Coast (PPGC), in Lufkin, Texas, talked recently with the Lufkin, Texas newspaper about what she saw:

The updated complaint, filed in October 2011, alleges that while Reynolds was employed as a health center assistant, she was instructed by the organization to maximize billing revenue when the government was fitting the bill through Medicaid and the Women’s Health Program.

She claims this was the procedure in all 12 Planned Parenthood Gulf Coast locations across Texas and Louisiana.

The suit alleges that, in addition to falsifying patient records, billing the government for unwarranted services and services not covered by Medicaid, Planned Parenthood tacked on services patient did not receive.

An example given in the suit is Medicaid being billed for birth control counseling. The suit states almost all Women’s Health Program and Medicaid patients were handed a bag of at least two birth control devices despite the fact the items were not needed or requested by the patient.

“Pursuant to corporate policy and instructions from clinical directors, after merely handing the patient a bag of condoms and vaginal film on the way out the door, clinic employees then entered billing codes to be submitted to the government” at an average billed cost of $57.85.

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.

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.