Judge: Planned Parenthood Abortion Biz Must Answer for Massive Medicaid Fraud Scheme

State   |   Steven Ertelt   |   May 21, 2014   |   12:07PM   |   Houston, TX

A judge has ruled that a Planned Parenthood abortion business must answer for allegations that it participated in a massive Medicaid fraud scheme. The claim involve blood tests that were performed on Texas teenagers by a Texas-based affiliate of the abortion giant.

According to a report:

Patricia Carroll brought the complaint in late 2012 after serving as the accounts receivable manager for Houston-based Planned Parenthood Gulf Coast Inc. for five years. In March of that year, she had allegedly noticed that a Planned Parenthood clinic in Huntsville experienced a revenue increase of more than 300 percent.

plannedparenthood34bCarroll investigated and claimed to have found that Planned Parenthood was billing Medicaid for STD and HIV blood tests performed by a nonphysician on teens at a private charter school, using billing codes to give the appearance the tests were done at its Huntsville clinic by a doctor.

The tests were allegedly performed on Medicaid-eligible youths at the Gulf Coast Trades Center, which contracts with Texas to provide job training for teens sent to the school under court order.

Carroll resigned that October and then filed a sealed qui tam action, an avenue for whistle-blowers with knowledge of fraud against the government to file a lawsuit on the government’s behalf and receive a cut of any settlement. The Houston resident filed her first amended complaint Monday after a partial dismissal from U.S. District Judge Sim Lake last week.

Acknowledging that Carroll’s allegations require deference at this stage of the case, Lake said Wednesday “that Carroll has adequately pleaded factual content that allows the court to draw the reasonable inference that Planned Parenthood knowingly filed false claims.”

This is the second such fraud case for the abortion business, as another Texas affiliate came under fire for fraud previously. The Planned Parenthood abortion business was forced to repay $1.4 million dollars in Texas last year.

In 2012, 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.

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.

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.