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Planned Parenthood accused of 87,000 fake claims
Posted By Bob Unruh On 03/10/2012 @ 9:40 pm In Front Page,Health,Politics,U.S. | No Comments
A lawsuit alleging that Planned Parenthood submitted more than 87,000 fraudulent claims – and pointing out that there could be an $11,000-plus penalty for each case – has been unveiled in a Texas dispute by attorneys representing former Planned Parenthood clinic director Abby Johnson.
The case alleges the nation’s abortion industry giant submitted “repeated false, fraudulent, and ineligible claims for Medicaid reimbursements” through the Texas Women’s Health Program.
“Americans deserve to know if their hard-earned tax money is being funneled to groups that are misusing it,” said Michael J. Norton, an ADF senior counsel. “No matter where a person stands on abortion, everyone should agree that Planned Parenthood has to play by the same rules as everyone else.
“It certainly isn’t entitled to a penny of public funds, especially if it is committing Medicaid fraud,” he said.
The case was filed originally under a federal law that allows “whistleblowers” with inside information to expose fraudulent billing by government contractors. By law, the cases are filed under seal and may not be made public while state and federal governments decide whether to join the action,
The case originally was filed in 2010 and names the Houston and Southeast Texas affiliate office of the abortion business.
Johnson is the former director of the Planned Parenthood business in Bryan/College Station. She is bringing the claims against Planned Parenthood under the Federal False Claims Act and the Texas Medicaid Fraud Prevention Act.
She fled the abortion business after she was summoned to help with an abortion and watched on a monitor as the unborn child fought for his life, and then died.
The claim is that Planned Parenthood knowingly committed Medicaid fraud from 2007 to 2009 by improperly seeking reimbursements from the Texas Women’s Health Program for billings that were not legally reimbursable by that program.
Planned Parenthood of Houston and Southeast Texas, now called Planned Parenthood Gulf Coast, according to the lawsuit, “filed at least 87,075 false, fraudulent, or ineligible claims with the Texas Women’s Health Program.”
“As a result,” the ADF explained, “Planned Parenthood wrongfully received and retained reimbursements totaling more than $5.7 million.”
The ADF said the money pipeline for Planned Parenthood recently was closed, when the state adopted a law that bans the state’s Medicaid agency from contracting with “affiliates of entities that perform or promote elective abortions.”
The case explains that “any person who knowingly submits or causes to be submitted a false or fraudulent claim to the government for payment or approval is liable for civil penalty up to $11,000 for each such claim submitted or paid, plus three times the amount of the damages sustained by the government..”
“Liability attaches both when a defendant knowingly seeks payment that is unwarranted from the government and when false records or statements are knowingly created or caused to be used to conceal, avoid, or decrease an obligation to pay or transmit money to the government.”
In the case paperwork, it is explained that while Johnson worked for Planned Parenthood, she was responsible for entering data about individual cases, and was “able to view all patient billing information, including insurance information, charges and payments.”
It was there she became “aware of the billing practices of Planned Parenthood as described herein.”
“In 2007, Planned Parenthood claims to have provided medical services and reproductive health services to individuals participating in 82,513 patient visits from which Planned Parenthood received program service revenue in the amount of $9,230,230. … A substantial amount of said revenue was earned by provision of medical services by Planned Parenthood billed to Medicaid and [women's health] programs and thus paid for by … the United States government and/or the state of Texas.
“On information and belief, in SFY2008, Planned Parenthood recived $1,950,669 in [women's health] reimbursements from the United States government and/or the state of Texas government for treating 9,029 patients with 66,687 procedures. In SFY2009, Planned Parenthood received $3,071,727…”
But the case alleges Planned Parenthood and its employees “combined, conspired, and agreed together and with each other to defraud the United States government and the state of Texas government by knowingly submitting and causing to be submitted …. false, fraudulent and/or ineligible claims.”
The case explains that was done by submitting claims for services that were not covered because the patients “were not seeking or receiving medical services for family planning…”
That, the lawsuit alleges, was done because Planned Parenthood officials ordered workers to “turn every call and visit into a revenue-generating client.”
“Planned Parenthood intiatied a scheme of fraudulent billing to offset its operating losses. This fraudulent billing was accomplished by assigning a fraudulent purpose for a patient visit that would otherwise be non-billable,” the case explains. “For example, a woman with an infection would not be eligible for a follow-up examination paid by WHP, since the exam must be with regard to family planning services, not general obstetrical care. … As instructed by Planned Parenthood, Ms. Johnson and others falsely notated the patient’s chart with services not, in fact, provided to the patient so as to create an otherwise non-reimbursable service into a reimbursable family planning product or service.”
The Planned Parenthood employee then would notify another employee, Stephanie Shetler, “of the false chart notation, and … Shetler would further document the fraud by making an additional false notation reflecting a family planning purpose, such as, ‘Discussed birth control with patient – patient decided to retain current method.’ Planned Parenthood’s center would then bill the examination [$300] to the WHP program, as well as non-family planning services provided in conjunction with the family planning examination.”
Johnson alleges that her supervisors acknowledged the improper billing, but then directed workers not to disclose that to the government.
The case also alleges Planned Parenthood rigged its books for audits and billed for services not provided. Officials told Johnson it was such a “hassle” to refund the money, they “try not to do that.”
Planned Parenthood previously has been accused in California of overbilling, and actually faces criminal charges in Kansas over its operations there. The abortion business claims over $1 billion in assets and yearly gets hundreds of millions of dollars from U.S. taxpayers.
The Planned Parenthood office Houston did not respond to a WND request for comment.
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