“No federal funds pay for abortion,” is Planned Parenthood’s favored response whenever taxpayer funding for the nation’s largest abortion provider is questioned. But even in spite of funding restrictions such as the Hyde Amendment, which prohibits Medicaid funds from being used directly for abortion (a restriction which Planned Parenthood unequivocally states it “strongly opposes”[i]), Planned Parenthood’s taxpayer funding subsidizes its abortion practice.
Federal law, even before Roe v. Wade, has been concerned about abortion providers like Planned Parenthood misusing “family planning” funds to support their abortion businesses. In the case of Title X “family planning” funding, for example, the law does not merely say that these funds are barred from being used for abortion directly, but also that these funds are not supposed to be used in “programs where abortion is a method of family planning.”[ii] The U.S. Department of Health and Human Services (HHS) notes that this restriction is one of the “five major provisions of [Title X],”[iii] and reiterates in its program policy guide that the “broad range of services” required by Title X “does not include abortion as a method of family planning.”[iv]
Problematically, Title X’s largest recipient, Planned Parenthood, encourages abortion as a means of “planning” a family. Planned Parenthood tells women that “Am I ready to become a parent?” is first among the questions to ask when considering an abortion.[v] Other questions Planned Parenthood proposes that indicate that it considers abortion as a legitimate means of family planning include: “Would I prefer to have a child at another time?” and “What would it mean for … my family’s future if I had a child now?”[vi]
Regardless of whether Planned Parenthood violates the spirit or the letter of the law by its promotion of abortion as a means of planning a family, the taxpayer dollars it receives are subsidizing its abortion business.
Abby Johnson, former director of a Planned Parenthood clinic in Bryan, Texas, has said, “As clinic director, I saw how money received by Planned Parenthood affiliate clinics all went into one pot at the end of the day – it isn’t divvied up and directed to specific services.”[vii]
Ms. Johnson’s account, that Planned Parenthood provides no meaningful separation of funds to ensure tax dollars do not subsidize its abortion business, is supported by the Commissioner of the Indiana State Department of Health’s analysis of Planned Parenthood’s commingling of funds with regards to Medicaid. In the ongoing case challenging Indiana’s abortion-funding restriction, the Commissioner notes that “[Planned Parenthood of Indiana]’s audited financial statements for 2009 and 2010 give rise to a reasonable inference that it commingles Medicaid reimbursements with other revenues it receives.”[viii]
The problem may run deeper than commingling of funds and using taxpayer dollars for shared overhead. Two recently unsealed “whistleblower” lawsuits allege that Planned Parenthood is illegally – and intentionally – funding its abortion services with taxpayer dollars.
Planned Parenthood Gulf Coast (PPGC) (an affiliate operating 10 clinics in Texas and 2 in Louisiana) has been accused of corporate-wide fraudulent billing practices by Ms. Karen Reynolds, a “Health Center Assistant” for nearly a decade at Planned Parenthood’s Lufkin, Texas clinic.[ix]
Among her claims, Ms. Reynolds alleges that PPGC “trained its employees to create false and misleading patient chart entries” in order to support reimbursements for services which were not permitted under the Texas Women’s Health Program (WHP) and Medicaid, including “obtaining payment for abortion-related services.”[x] Thus, PPGC would improperly charge the government – and, ultimately, American taxpayers – for abortion-related services.
Ms. Reynold’s account is similar to the scenario outlined in a second “whistleblower” suit, filed by Sue Thayer against the Planned Parenthood of the Heartland affiliate, where she was employed for 17 years at its Storm Lake, Iowa clinic.[xi]
Ms. Thayer’s complaint explains how Planned Parenthood’s “fragmentation” billing practice extended beyond the post-abortion visit.
[I]n a practice commonly referred to as “fragmentation,” Defendant Planned Parenthood of the Heartland knowingly and intentionally separated out charges for services and products rendered in connection with such abortions, including, without limitation, office visits, ultrasounds, Rh factor tests, lab work, general counseling, and abortion aftercare, and submitted such separate “fragmented” charges as claims for Title XIX-Medicaid reimbursement to Iowa Medicaid Enterprise and/or Iowa Family Planning Network.[xii]
Charging the taxpayer for these services and products effectively subsidizes abortion. Ms. Thayer alleges that “in anticipation of the receipt of reimbursements for such separate ‘fragmented’ charges…Planned Parenthood of the Heartland then reduced the usual and customary charges to clients to whom abortions had been provided.”[xiii] Ms. Thayer states that “[t]he unbundling or fragmentation scheme was applied systematically to virtually every client who received an abortion.”[xiv]
It seems that Planned Parenthood’s claim that it is abiding by federal and state laws prohibiting abortion funding may depend on what the definition of “is” is. Through commingling, unbundling, and fragmenting, the American taxpayer appears to be playing a consequential role in Planned Parenthood’s abortion business.
[i] See Planned Parenthood Federation of America Statement Regarding Cut to Title X National Family Planning Program, Planned Parenthood, Dec. 16, 2011, available at https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-federation-america-statement-regarding-cut-title-x-national-family-planning-38384.htm (last visited Sept. 14, 2012).
[ii] 42 U.S.C §300a-6 (Title X, §1009, as added Dec. 24, 1970, Pub. L. No. 91-572, §6(c), 84 Stat. 1508). Since its inception, Title X has reflected popular opinion that abortion is not “family planning” and should not be funded at taxpayers’ expense.
[iii] See U.S. Dep’t of Health & Human Servs., Office of Population Affairs, Policy and Planning: Title X Statute and Regulations, available at https://www.hhs.gov/opa/title-x-family-planning/title-x-policies/statutes-and-regulations/ (last visited Sept. 14, 2012).
[iv] See U.S. Dep’t of Health & Human Servs., Office of Population Affairs, Program Priorities, available at https://www.hhs.gov/opa/title-x-family-planning/title-x-policies/program-priorities/ (last visited Sept. 14, 2012).
[v] See Planned Parenthood Fed’n of Am., Thinking About Abortion, available at https://www.plannedparenthood.org/health-topics/pregnancy/thinking-about-abortion-21519.htm (last visited Sept. 14, 2012).
[vii] See, e.g., Abby Johnson, Opinion: Defund Planned Parenthood, AOL News (Mar. 8, 2011), available at https://www.aolnews.com/2011/03/08/opinion-defund-planned-parenthood/ (last visited Sept. 12, 2012).
[viii] Def’s Mem. In Opp’n to the Mot. for Prelim. Inj. at 1. see Exhibit A-B at 21 (FY 2009 Audit); see also Exhibit A-C at 22 (FY 2010 Audit).
[ix] In August, a federal district court ruled that Ms. Reynolds’s allegations, if proved true, constitute fraud and her case can proceed. Order granting in part Defendant’s motion to dismiss, Reynolds v. Planned Parenthood, (E.D. Tex. Aug. 10, 2012) available at https://c0391070.cdn2.cloudfiles.rackspacecloud.com/pdf/reynolds-motion-to-dismiss-order.pdf (last visited Sept. 14, 2012).
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[x] Third Amended Complaint at 30, United States and Texas ex rel Reynolds v. Planned Parenthood Gulf Coast, No. 9-09-cv-125)(E.D. Tex. Oct. 28, 2011) For example, abortion follow-up visits are not reimbursable under Medicaid or the Texas WHP. In her complaint, Ms. Reynolds recounts that in order to receive government reimbursement for the abortion follow-up, the visit was coded as a Well Woman Exam or a birth control visit and the clinic employees were instructed to simply make a note in the “chief complaints” or “subjective section” that the “client had a surgical or medical abortion ‘x’ weeks ago.” Ms. Reynolds states that PPGC clinic employees were given “express instruction to document in a patient chart that the reason for a patient’s visit was to have the Well Woman Exam” even where that patient “had clearly indicated the purpose of the visit was a post-abortion follow-up.”
[xi] Second Amended Complaint at 45, United States and Iowa ex rel Thayer v. Planned Parenthood of the Heartland, No. CV00129 (S.D. Iowa July 26, 2012).
[xii] Id. at 96.
[xiii] Id. at 97.
[xiv] Id. at 99.
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