A whistleblower's lawsuit accusing a Planned Parenthood branch of scamming American taxpayers millions of taxpayer dollars has been reinstated by a federal appeals court.
The action was brought in 2011 by Sue Thayer, former manager of Iowa's Storm Lake and LeMars Planned Parenthood clinics. Thayer sued the organization under both federal and Iowa False Claims Acts. She alleges Planned Parenthood knowingly committed Medicaid fraud from 2002 to 2009 by seeking improper and even illegal reimbursements from Iowa Medicaid Enterprise and the Iowa Family Planning Network.
A district judge in 2012 dismissed the complaint at Planned Parenthood's request, but the 8th U.S. Circuit Court of Appeals has returned it to district court.
"We conclude that Thayer has pled sufficiently particularized facts to support her allegations that Planned Parenthood violated the FCA by filing claims for (1) unnecessary quantities of birth control pills, (2) birth control pills dispensed without examinations or without or prior to a physician's order, (3) abortion-related services, and (4) the full amount of services that had already been paid, in whole or in part, by 'donations' Planned Parenthood coerced from patients," the appeals court ruling said.
TRENDING: To DEI for
"Thayer adequately alleges the particular details of these schemes, such as the names of the individuals that instructed her to carry out these schemes, the two-year time period in which these schemes took place, the clinics that participated in these schemes, and the methods by which these schemes were perpetrated. Moreover, she alleges that her position as center manager gave her access to Planned Parenthood's centralized billing system, pleads specific details about Planned Parenthood's billing systems and practices, and alleges that she had personal knowledge of Planned Parenthood’s submission of false claims.
"Thayer's claims thus have sufficient indicia of reliability because she provided the underlying factual bases for her allegations," the ruling said.
Her allegation Planned Parenthood violated the FCA by causing other hospitals to unknowingly submit claims "and by upcoding" was not permitted by the court.
A statement released earlier from the abortion organization blasted the lawsuit as "harassment."
But ADF Senior Counsel Casey Mattox said Americans "deserve to know if their hard-earned tax money is being funneled to groups that are abusing it."
"No matter what people believe about abortion itself, everyone can agree that Planned Parenthood should play by the same rules as everyone else," he said. "We look forward to continuing our defense of the American taxpayer in this case."
The lawsuit alleges Planned Parenthood submitted "repeated false, fraudulent, and/or ineligible claims for reimbursements" to Medicaid.
"These included billing Medicaid for abortion-related services in violation of federal law, deceptively seeking partial payments from Medicaid patients but billing Medicaid for the full amount, billing Medicaid for contraceptives without any examination or even a proper prescription, and billing Medicaid for more expensive services than those provided."
The laws under which the claim was filed allow whistleblowers with inside information to expose fraud.
Planned Parenthood fired Thayer over her opposition to its "webcam" abortions, which allowed abortion drugs to be prescribed to women without a personal meeting with a doctor. On Aug. 19, an Iowa court upheld the Iowa Board of Medicine's new ban on the procedure.
"Planned Parenthood repeatedly demonstrates that it cares more about protecting its own bottom line than about protecting the women it purports to serve," said ADF Senior Counsel Michael J. Norton. "That's been a pattern with Planned Parenthood across the county."
The lawsuit claims Planned Parenthood's "C-Mail" scam began by automatically sending a year's supply of birth control pills to women who came into one of the organization's clinics. The pills were usually sent without a physician's order, often dispensed to women "at levels not medically reasonable or necessary … constituting 'abuse or overuse'" and were even shipped without the patient's consent or foreknowledge.
Planned Parenthood then billed Medicaid for $26.32 for each month's worth of pills, the lawsuit claims, even though the cost to the clinics was only $2.98.
Thayer claims the scam proved to be so profitable Planned Parenthood even held competitions among its clinics to see which of them could enroll the most women in the "C-Mail" program.
Furthermore, the lawsuit claims, the U.S. Postal Service sometimes returned the packages to Planned Parenthood, but instead of crediting Medicaid or destroying the returned pills, the clinics resold the birth control pills and billed Medicaid twice for the same medication.
A second claim within the lawsuit alleges that though both Iowa and federal law bar taxpayer funds from reimbursing abortion services, Planned Parenthood found a way to sidestep the restriction.
The lawsuit claims rather than billing Medicaid for abortions directly – a clear violation of the law – Planned Parenthood "fragmented" the patients' bills so it could charge Medicaid for everything the clinic did around and related to the abortion. The charges included, "without limitation, office visits, ultrasounds, Rh factor tests, lab work, general counseling and abortion aftercare, all of which were, when provided, integral to and/or related to surgical and medical abortion procedures."
Still another allegation is that Planned Parenthood asked its Medicaid patients to "donate" to the organization half the cost of their bill, a request with which many patients complied. But then, the lawsuit says, Planned Parenthood reported the money as a "voluntary donation" and still billed Medicaid for the full amount of the patient's care.
Â