Archive for Karen Reynolds

Former Planned Parenthood staffers explain how Medicaid fraud is being committed

Posted in Abortion Quota, Planned Parenthood Abortion Quota, Planned Parenthood former employee, Planned Parenthood illegal activity, Planned Parenthood medicaid fraud with tags , , , , , , , , , , , , , , , , , , , , , , , , on October 16, 2017 by saynsumthn

|  (From Live Action News)

In 2015, seven former Planned Parenthood (PPFA) employees informed the House Energy and Commerce Subcommittee on Oversight and Investigations that Planned Parenthood should be investigated for a number of potentially criminal and fraudulent acts. These former employees told Committee members in a formal letter that because Planned Parenthood receives half a billion in taxpayer funding annually, Planned Parenthood should “[…] merit close Government attention as to whether or not these funds are being spent appropriately.”

The former Planned Parenthood staffers’ letter noted, “we are of one mind that the extent of theses problems with the organization is not fully understood by the American people….” They added that they “could personally attest” that Planned Parenthood has “operated as a law unto itself, gladly accepting tens of millions of dollars of taxpayer support while using the rubric of ‘reproductive rights’ to claim exemption from the normal standards of accountability that every other recipient of public funds is expected to meet.”

In recent years, additional former Planned Parenthood staffers have come forward to accuse the abortion corporation of fraudulently overbilling Medicaid, milking American taxpayers for millions of dollars.

READ: Half of WI Planned Parenthood’s Medicaid payments were fraud, auditors say

Karen Reynolds

In August 2013, the whistleblower case of Karen Reynolds, a former employee of Planned Parenthood Gulf Coast, resulted in the Houston-based Planned Parenthood affiliate paying $4.3 million to resolve civil allegations made by Reynolds under the False Claims Act in the Eastern District of Texas. According to a Department of Justice release:

The government alleged that between 2003 and 2009, Planned Parenthood Gulf Coast billed and was paid by government programs, Texas Medicaid, Title XX, and the Women’s Health Program, for certain items and services related to birth control counseling, STD testing and contraceptives when such items and services were either not medically necessary, not medically indicated or not actually provided.

According to a 2017 report called “Profit No Matter What,” published by Alliance Defending Freedom (ADF) and the Charlotte Lozier Institute (CLI), Planned Parenthood’s facilities were required “to constantly increase their ‘pay per visit’ goals which were the bills charged to Medicaid for every patient visit.”

A recent interview with former Planned Parenthood manager, Sue Thayer, indicated that Planned Parenthood also had abortion quotas:

Patricia Carroll

Patricia Carroll was employed as the Accounts Receivable Manager by Planned Parenthood Gulf Coast and stated in her claim against Planned Parenthood that she noticed “a large revenue increase” of 314.76% for PP in Huntsville “while preparing the monthly Projection report.” The Dallas Morning News said about Carroll’s Medicaid fraud accusation:

Carroll worked as the accounts receivable manager at Planned Parenthood Gulf Coast from 2007-2012. In that position, she said she discovered “a fraudulent Medicaid scheme” that dated back to 2002. She alleged that a Planned Parenthood clinic in Huntsville had an employee visit a charter school called Gulf Coast Trade Center and perform STD/HIV tests on the students there, all of whom receive Medicaid benefits.

Carroll said Planned Parenthood incorrectly coded the visits to collect Medicaid reimbursements, estimating the clinic received about $200 per student. “Thousands of claims were filed” in the ten year span, according to Carroll’s original complaint.

In May 2014, a federal district judge in Houston ruled that Carroll had “adequately pleaded factual content that allows the court to draw the reasonable inference that Planned Parenthood knowingly filed false claims.”

The ADF/CLI report added that “at least some of the services were not medically necessary due to the duplication of visits, teens already having been tested at the jails or court systems they came from, and the higher-level staff already onsite at the school who could provide the same testing and education at no cost.”

Carroll’s lawsuit was dismissed on January 29, 2016, for an undisclosed settlement amount, the ADF/CLI report states.

Victor Gonzalez’s complaint against Planned Parenthood

P. Victor Gonzalez

P. Victor Gonzalez was employed as Vice President of Finance and Administration by Planned Parenthood of Los Angeles (PPLA). Gonzalez accused Planned Parenthood affiliates in California of marking up the cost of birth control drugs between 1997 and 2004 for government reimbursement, resulting in improper reimbursements — at taxpayer expense — far in excess of $200 million.

“An internal email from Gonzalez states that PPLA’s actual acquisition cost for oral contraceptive pills was $1-2, but that it was charging the government $12-48 per pack – a ‘hefty markup’ ‘proscribed by DHS regulations.’ Gonzalez estimates the impact on PPLA alone as approximately $4 million in revenues in a single typical year,” the ADF/CLI report states.

Sue Thayer

Sue Thayer, former manager for Planned Parenthood of the Heartland’s Storm Lake and LeMars facilities in Iowa, claimed Planned Parenthood defrauded Medicaid out of millions by overcharging for services, illegally billing for abortion-related care.

In 2015, Thayer testified before a Congressional committee about the claim, accusing Planned Parenthood of filing “[…] false claims totaling about $28 million with Iowa’s Medicaid program for (1) illegally dispensing “medically unnecessary” quantities of oral contraceptive pills and birth control patches to C-Mail Medicaid patients and doing so without a prescription; (2) fraudulently billing the Iowa Medicaid program for abortion-related services; and (3) coercing “donations” from Medicaid patients.

In an op-ed Thayer wrote in 2017, she elaborated further:

Planned Parenthood advertises that services and supplies are free, but when Medicaid-eligible women are served, it is expected they donate fifty percent of the total cost for the visit…. Planned Parenthood receives $542,000,000 in federal funding, yet asks women who live at or below the poverty line, who depend on federally-funded healthcare to make a donation — proof that Planned Parenthood is much more concerned about its bottom line than women in need.

“Planned Parenthood counted those payments as voluntary donations and billed the full amount to Medicaid,” Thayer recounted in her 2015 testimony, adding, “There is a reason that, despite technically being a nonprofit, Planned Parenthood has reported $765 million in excess revenue over the last 10 years. It is run very much like a business – focused on increasing revenues, placing its own bottom line above the interests of women. And yet leadership would take expensive trips to Europe and Russia and throw elaborate parties at fancy venues.”

In addition, Thayer discussed the alleged fraud accusations in the video below:

Abby Johnson

Abby Johnson, the former director of an abortion center operated by Planned Parenthood Gulf Coast, (formerly Planned Parenthood of Houston and Southeast Texas) accused Planned Parenthood in her lawsuit of “repeated false, fraudulent, and ineligible claims for Medicaid reimbursements” through the Texas Women’s Health Program:

In violation of its duty to report such false, fraudulent, and/or ineligible claims and/or to reimburse the United States and/or the State of Texas for monies wrongfully received by Planned Parenthood of the Gulf Coast, Planned Parenthood Gulf Coast knowingly or willfully concealed the making of such false, fraudulent, and/or ineligible claims and knowingly or fraudulently retained funds which Planned Parenthood Gulf Coast knew it was not entitled to retain.

According to the ADF/CLI report, Johnson “alleged that Planned Parenthood of Houston and Southeast Texas filed at least 87,075 false, fraudulent, or ineligible claims with the Texas Women’s Health Program.”

As a result, Planned Parenthood wrongfully received and retained reimbursements totaling more than $5.7 million, Johnson alleged.

Abby Johnson alleges millions in fraud by Planned Parenthood

According to a report published by LifeSiteNews, the lawsuit also claimed:

… Planned Parenthood held a meeting in late 2008 or early 2009 to inform its clinic directors that it had been falsely billing the Texas WHP since January 1, 2007.  Johnson says that when she asked “what are we going to do about” the money that Planned Parenthood had improperly received, her supervisor answered, “Well, we are going to hope we don’t get caught.”

Ramona Trevino

A 2017 op-ed written by Ramona Trevino, a former Planned Parenthood North Texas facility manager, claimed further that “Medicaid patients are like mini cash cows for Planned Parenthood.” Trevino added, “Patients who went to Planned Parenthood abortion centers used federal funds to pay for post-abortion exams at Planned Parenthood’s non-abortion centers….”

Today, due in part to the broken promises of politicians to defund Planned Parenthood, American taxpayers are still forced to hand over $1.5 million per day to this fraudulent organization.

Government tax dollars going to Planned Parenthood in just the past ten years now total in the billions of dollars with little to no oversight, while Planned Parenthood continues to send hefty “campaign contributions” to its allies through its political arm. And, despite accusations of fraud, another half a billion in taxpayer dollars is slated to be handed over to Planned Parenthood in 2018.

It is past time to stop this abuse and defund Planned Parenthood.

  • This article is reprinted with permission. The original appeared here at Live Action News.

Planned Parenthood’s fraud that Texas is pulling funds for political reasons

Posted in Medicaid Billing Practices, Planned Parenthood Medicaid Contract, Planned Parenthood medicaid fraud, Texas Abortion with tags , , , , , , , , , on October 23, 2015 by saynsumthn

This week, the state of Texas informed Planned Parenthood of its plan to remove its affiliates from the state’s Medicaid program. The announcement came after revelations that Planned Parenthood and specifically their Houston affiliate, Planned Parenthood Gulf Coast ( PPGC) is involved in a baby harvesting operation which has caused the nation to recoil in horror.

Planned Parenthood Houston  abortion mega

Investigators from the Center for Medical Progress, posing as buyers for a Biotech company captured under cover conversations with the Director of Research for Planned Parenthood Gulf Coast, Melissa Farrell. Farrell was recorded offering intact fetal cadavers for research as a “matter of line items.”

Alter-process-intact-fetal-cadavers-Planned-Parenthood

In addition to mentioning the CMP video, the letter obtained by Live Action News from Texas Health and Human Services Commission’s inspector general, Stuart Bowen, tells Planned Parenthood Gulf Coast that his office had information suggesting that, “fraud and other related program violations have been committed by a number of Planned Parenthood affiliates enrolled in the Medicaid program in Texas, including you.”

Planned Parenthood clinics in Texas received $3.05 million in federal funds through Medicaid for family planning services last year, according to a report in the Texas Tribune.

The letter also states that the Planned Parenthood Gulf Coast is “liable directly, or by affiliation for a series of serious Medicaid program violations,” and that Planned Parenthood affiliates in the state are, “no longer capable of performing medical services in a professionally competent, safe, legal and ethical manner.”

The letter details cases where Planned Parenthood’s credibility as a Medicaid provider for the state was called into question:

    “In Reynolds, a Planned Parenthood Whistleblower alleged sufficient evidence of fraud to assure the federal court handling the matter that the case was worth pursuing, after which Planned Parenthood promptly settled the lawsuit for $4.3 million. Furthermore, when the United States Department of Justice (DOJ) announced the 2013 settlement in Reynolds, it openly and compellingly criticized PPGC for “abuse of programs that are extremely important to the well-being of many American women.” Further, the DOJ was “particularly grateful to the Whistleblower” who came forward for revealing that Planned Parenthood Gulf Coast had billed the Texas Medicaid program, Title XX, and the Women’s Health Program “for items and services that were either medically unnecessary or were never actually provided.”

In the 2013 case mentioned in the letter, the state had accused Planned Parenthood of submitting more than $30 million in fraudulent bills between 2003 and 2009.

In addition to the Reynolds case, in 2014, another whistle-blower case alleged that PPCG defrauded Medicaid with regard to blood tests performed on Texas teens. The case was brought by Patricia Carroll who served for several years as the accounts receivable manager for Planned Parenthood Gulf Coast. The complaint stated that Carroll noticed “a large revenue increase” of 314.76% for a Planned Parenthood clinic in Huntsville while preparing the monthly projection report.

Patricia Carroll

Rather than looking at the hard cold facts that the citizens of Texas should not be forking over hard earned tax monies to an organization embroiled in so many accusations of fraud, the media is attempting to paint Planned Parenthood as some sort of a victim. And, although there are thousands of options for women’s healthcare in the state of Texas, other than Planned Parenthood, PPGC spokeswoman Rochelle Tafolla called the move by Texas “politically motivated.”

Planned Parenthood Medicaid revoked Texas

But, while the media publishes Planned Parenthood’s faux outrage the organization’s mother ship in the state, PPCG is hardly lacking financially. According to Planned Parenthood Gulf Coast’s most recent 990 report the Houston abortion business netted over $43 million dollars in assets by the end of 2013. In addition, 10 out of 11 officers or staff listed on the Planned Parenthood report made a hefty six digit salary.

PPGC 2013 990

PPCG interest 2013 990

PPGC’s statement of revenue shows $8,941,664 in total revenue that year which included $920,368 in government grants and $7,577,972 in contributions, gifts, and other grants. And, between 2009 and 2013, PPGC reported receiving $30,830,0483 in gifts, grants or contributions earning a whopping $3,603,781 in interest, dividends, and other investment income. In other words, Planned Parenthood Gulf Coast alone potentially earns as much revenue in interest as the amount the state of Texas is pulling through the state Medicaid program. So, when Planned Parenthood claims that women will be hurt by the mere $3 million state dollars the taxpayers will no longer have to pay through Medicaid, they are misleading the public.

$1.4 Mil for ex- ‪Planned Parenthood‬ employee after Obama DOJ settlement against the abortion giant

Posted in Medicaid Billing Practices, Planned Parenthood employee sues, Planned Parenthood Employee Testifies against them, Planned Parenthood ex employee, Planned Parenthood lawsuit, Planned Parenthood lies, Planned Parenthood medicaid fraud with tags , , , , , , , on August 2, 2013 by saynsumthn

According to Jill Stanek, The good people at Alliance Defending Freedom have forwarded me the settlement agreement between Planned Parenthood Gulf Coastand the United States of America, the Texas Attorney General, and whistleblower Karen Reynolds, for charges that PPGC committed Medicaid fraud between 2003-2009. The settlement was signed by all parties on July 24 and 25.

As I wrote yesterday, PPGC has agreed to pay $4.3 million. According to the settlement, the money will be divided three ways:

$2,552,169 – United States
$1,247,000 – Karen Reynolds (bounty)
$500,831 – State of Texas

In addition, PPGC must pay Reynolds’ attorney fees. Reynolds was represented by the American Center for Law and Justice.

Read More here

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 alleged 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.

Case AGAINST abortion giant Planned Parenthood advances in Court

Posted in Financial mismanagement, Medicaid Billing Practices, Planned Parenthood employee sues, Planned Parenthood Investigated, Planned Parenthood lawsuit, Planned Parenthood medicaid fraud, Planned Parenthood Whistleblowers with tags , , , , , , , on August 14, 2012 by saynsumthn

Posted from the ACLJ Aug. 13, 2012

Our federal lawsuit against Planned Parenthood in Texas alleges that the abortion giant defrauded taxpayers by charging state and federal governments for services not actually provided, medically unnecessary services, and services that are not covered under Medicaid and other programs.

On Friday, a federal court agreed with the ACLJ that these allegations, if proven, constitute fraud in violation of federal law. The federal court in Texas denied Planned Parenthood’s attempt to have this critical case against the abortion giant thrown out.

This is a major victory as this case to hold Planned Parenthood accountable moves forward to trial. At stake are literally hundreds of millions of dollars, and it is a case that could have a substantial impact on one of Planned Parenthood’s largest affiliates in Texas.

The federal court noted that our lawsuit on behalf of former Planned Parenthood employee turned whistleblower, Karen Reynolds, “asserts that these false claims were submitted to the United States and Texas governments for reimbursement and, to support its claims for payment, [Planned Parenthood] regularly falsified patient charts.”

As the court also noted, Planned Parenthood merely argues that “there is nothing fraudulent about a policy to maximize revenues.” The Court didn’t buy that argument and held that if our client’s allegations are proven, it would show that Planned Parenthood engaged in a “fraudulent scheme to maximize revenues” in violation of federal law “on a regular if not daily basis” over the course of at least ten years.

This court decision is also a major victory in light of a recent decision from a California federal court throwing out a similar case against Planned Parenthood there. The ACLJ has already successfully appeal that case to the Ninth Circuit Court of Appeals once, and is preparing to appeal the trial court’s second attempt to throw the case out on a technicality.

The federal district court in California held that fraudulent overbilling of the government does not constitute a “false” claim. We are arguing on appeal, and as the federal court in Texas agreed, Planned Parenthood’s alleged fraudulent actions do violate federal law.

Both of these cases against the largest abortion provider in America are critically important in the fight for life and against continued taxpayer funding for the abortion business. We will continue to keep you informed as these cases proceed.

For more on the practices of Planned Parenthood read: Many reasons to defund Planned Parenthood: eugenics, racism, abortion, audits, misappropriation of funds, Medicaid billing practices, hiding sexual predators

Another whistleblower sues Planned Parenthood claims the tax funded abortion giant is guilty of Medicaid Fraud

Posted in Financial mismanagement, Former Planned Parenthood Employee, Medicaid Billing Practices, Planned Parenthood Employee, Planned Parenthood employee sues, Planned Parenthood medicaid fraud, Planned Parenthood Whistleblowers with tags , , , , , , , , , , on July 10, 2012 by saynsumthn

The Alliance Defending Freedom(formerly the Alliance Defense Fund) is representing Sue Thayer, a former Planned Parenthood of the Heartland Clinic manager in a lawsuit filed in March, 2011. The complaint by law was not allowed to be made public until a court unsealed it which happened recently. The ADF attorneys filed suit under a federal law that allows “whistleblowers” with inside information to expose fraudulent billing by government contractors.


Thayer, who is a former manager of Planned Parenthood’s clinics in Storm Lake, IA and LeMars, IA has sued under both the federal and Iowa False Claims acts. The suit alleges that Planned Parenthood knowingly committed Medicaid fraud from 2002 to 2009 by improperly seeking reimbursements from Iowa Medicaid Enterprise and the Iowa Family Planning Network for products and services that were not legally reimbursable under those programs.

Thayer in the lawsuit alleges that Planned Parenthood of Greater Iowa, now known as Planned Parenthood of the Heartland, filled nearly 500,000 false claims with Medicaid from which Planned Parenthood received and retained nearly $28 million. If the court rules in favor of Thayer, Planned Parenthood of the Heartland could be ordered to pay both the federal and Iowa governments as much as $5.5 billion in False Claims Act damages and penalties.

In the lawsuit, Thayer alleges that in order to enhance revenues, Planned Parenthood implemented what is called the “C-Mail” program which automatically mailed a year’s supply of birth control pills to women who had only been seen once at a Planned Parenthood clinic. Those women, the lawsuit explains, were usually seen by personnel who were not qualified health care professionals.

Planned Parenthood’s cost for a 28-day supply of birth control pills mailed to clients was $2.98, but Thayer asserts that the actual Medicaid reimbursement received by Planned Parenthood was $26.32. After being seen only once clients were mailed thousands of unrequested birth control pills. The lawsuit also alleges that when the Postal Service returned the pills in some cases Planned Parenthood would resell the same birth control pills and bill Medicaid again instead of crediting Medicaid or destroying the pills.

Read Rest Here

In a Washington Times Op-ed penned by Sue Thayer, the Planned Parenthood whistle blower states, “So what does Planned Parenthood, the “trusted friend of women,” love so much about telemed abortions? Low overhead costs. My superiors justified telemed abortions, lauding the financial benefits of not having to worry about or pay for specialized equipment, staff and a traveling physician – all required with surgical abortions. When I expressed my concerns, I was “let go,” supposedly because of ‘downsizing.’ ”

________________________________________________________________________________________________

And in Texas…..According to a Lufkin Daily News Article entitled: Former Lufkin clinic employee alleges fraud in suit against Planned Parenthood

Planned Parenthood Gulf Coast is a defendant in a federal lawsuit after a former Lufkin clinic employee alleged a multi-million-dollar billing scheme.

The complaint names Karen Reynolds as the whistle-blower in the allegations brought against her former employer of 10 years.

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.

If Planned Parenthood Gulf Coast loses the case set for trial in April 2013, Reynolds, the federal government and the state of Texas will be owed a sum of money by the corporation known for family planning and women’s health issues.

Reynold’s attorney Mike Love said the case is in its early stage. While he said he was reluctant to comment on the case due to its magnitude, Love said on the behalf of his client, “if an entity is not billing properly, it doesn’t matter if it’s Planned Parenthood, a large hospital facility or a local doctor’s office — fraud is fraud.”
A phone call to an attorney representing Planned Parenthood was not returned as of 5 p.m. Friday.

Read Complaint Here

READ: Whistleblower alleges Texas Planned Parenthood committed massive Medicaid fraud
_________________________________________________________________________________________________________________________________________________________________________

According to the ACLJ who is representing another Planned Parenthood whistleblower:

P. VICTOR GONZALEZ, has accused the Planned Parenthood (PP) affiliates in California of also marking up the supposed cost of various birth control drugs when seeking government reimbursement, resulting in tens of millions of dollars of overbilling-at taxpayer expense.

Read that complaint here

Also READ: Many reasons to INVESTIGATE abortion giant Planned Parenthood – spelled out in gruesome detail!

READ: Many reasons to defund Planned Parenthood: eugenics, racism, abortion, audits, misappropriation of funds, Medicaid billing practices, hiding sexual predators

Planned Parenthood in Texas accused of multi-million-dollar billing scheme by former employee

Posted in Financial mismanagement, Planned Parenthood Employee, Planned Parenthood employee sues, Planned Parenthood Investigated, Planned Parenthood lawsuit, Planned Parenthood lies, Planned Parenthood rich off taxpayers, Planned Parenthood Whistleblowers with tags , , , , , on February 13, 2012 by saynsumthn

Former Lufkin clinic employee alleges fraud in suit against Planned Parenthood
Posted: Sunday, February 12, 2012 1:15 am
By JESSICA COOLEY/The Lufkin News

Planned Parenthood Gulf Coast is a defendant in a federal lawsuit after a former Lufkin clinic employee alleged a multi-million-dollar billing scheme.

The complaint names Karen Reynolds as the whistle-blower in the allegations brought against her former employer of 10 years.

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.

If Planned Parenthood Gulf Coast loses the case set for trial in April 2013, Reynolds, the federal government and the state of Texas will be owed a sum of money by the corporation known for family planning and women’s health issues.

Reynold’s attorney Mike Love said the case is in its early stage. While he said he was reluctant to comment on the case due to its magnitude, Love said on the behalf of his client, “if an entity is not billing properly, it doesn’t matter if it’s Planned Parenthood, a large hospital facility or a local doctor’s office — fraud is fraud.”
A phone call to an attorney representing Planned Parenthood was not returned as of 5 p.m. Friday.

Read Complaint Here

READ: Whistleblower alleges Texas Planned Parenthood committed massive Medicaid fraud

READ: Many reasons to INVESTIGATE abortion giant Planned Parenthood – spelled out in gruesome detail!

READ: Many reasons to defund Planned Parenthood: eugenics, racism, abortion, audits, misappropriation of funds, Medicaid billing practices, hiding sexual predators

Whistleblower alleges Texas Planned Parenthood committed massive Medicaid fraud

Posted in Financial mismanagement, Medicaid Billing Practices, Planned Parenthood Employee, Planned Parenthood employee sues, Planned Parenthood Investigated, Planned Parenthood lawsuit, Planned Parenthood rich off taxpayers, Planned Parenthood Whistleblowers with tags , , , , , , , on November 3, 2011 by saynsumthn

Jill Stanek is reporting:

Whistleblower alleges Texas Planned Parenthood committed massive Medicaid fraud

A former employee of Planned Parenthood Gulf Coast has filed a whistleblower’s complaint with both the Texas and United States Attorneys General alleging her management engaged in massive Medicaid fraud. ( Read here )

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, has 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.

PPGC operates 10 clinics in Texas – including, at seven stories and 78,000 sq ft, the largest abortion clinic in the U.S., located in Houston (pictured left, with PPGC CEO Peter Durkin in the foreground) – and two in Louisiana.

PPGC’s bilking scheme was elaborate and, frankly, fascinating. It allegedly involved several corporate officers, including Durkin (also pictured right with Planned Parenthood Federation of America CEO Cecile Richards in 2009) as well as board members, clinic directors, assistant clinic directors, health care assistants, and nurse practitioners.

According to the complaint, each clinic was given annual, monthly, and daily government revenue goals.
In conjunction, monthly staff meetings that included PowerPoint presentations were held at all clinics to train how to maximize government revenue.
PPGC went so far as to send employees from “under-performing” clinics to “higher-performing” clinics to learn how to increase revenue, which included double-billing.

One-size-fits-all billing
According to the complaint:
The scheme included the express policy of billing these government health care programs for a predetermined list of reimbursable services for every eligible patient who visited the clinic, regardless of whether those services were medically necessary or ever actually provided to the patient….
PPGC policy regarding which medical services to provide and bill for depended in large part on who was paying the bill…. [S]elf-pay patients were provided services based on medical necessity. WHP, Medicaid, and Title XX patients, however, were provided a series of predetermined services based on what those programs would pay for with the result that patients covered by government health programs were often provided services on an “across the board” basis even when such services were not medically necessary. The medical testing services most commonly provided to Medicaid and Title XX patients on an “across the board” basis… are:
a) Gonorrhea testing (Codes 87590 and 87591);
b) Chlamydia testing (Codes 87490 and 87491);
c) HIV testing;
d) Syphilis testing;
e) urinalysis (Codes 81002 and 81015);
f) hemoglobin blood count testing (Code 85018); and,
g) pregnancy testing

Because Medicaid guidelines allow for reimbursement for counseling on primary birth control and back-up bc, each Medicaid/WHP-eligible patient was also billed for both for every visit, although such counseling was not necessary and not given.
Another trick was to hand every contracepting patient a bag of condoms and vaginal film on her way out the door, despite the fact they were not needed or requested. This allowed PPGC to bill the government for, according to the complaint:

a. Condoms $4.20
b. Vaginal film $12.60
c. Method counseling $30.60 (Primary method, plus film and condoms as ‘back-up’ $10.20 X 3)
d. Problem counseling $10.45 (Under PPGC procedures, handing out condoms justified billing the government for ‘problem counseling’ because condoms are also used to prevent STD’s) (Code 99402 + Modifier FP [$10.45])

Isn’t it illegal to bill the government for abortions?
The biggest bombshell in the complaint comes on page 15, which describes how PPGC falsified charts of aborting or post-abortive patients to appear as if their visit was for another reason. It is illegal under the Hyde Amendment for federal taxpayer dollars to fund abortions unless for rape, incest, or life of the mother. But PPGC found ways around this. Quoting from one PPGC memo listed in the complaint:

POST AB VISITS:
We must work these clients in! This visit is self-pay. Quote the self-pay price then ask if she needs any other services such as birth control. If she is interested, screen for WHP or Title XX and offer the WWE [Well Woman Exam]. If the client is getting on birth control make this the focus of the visit and put a note in the chief complaints that the client had a surgical or medical abortion “x” weeks ago.

To pro-lifers, this information is the proverbial smoking gun, showing more than that the line of demarcation between federal funds and abortion is fungible, but that at least this Planned Parenthood worked the system to illegally obtain taxpayer dollars for abortion-related services.

Super billing

In addition, patient records were double-checked after visits against a “super bill” inserted into each chart that listed all possible government-reimbursable services. If more charges could be eked out, they were, regardless of whether or not the services were performed. In those cases charts were returned to nurses for back-charting, to add those services in the record.

In all, Reynolds is alleging six counts against PPGC for violating the Federal False Claims Act and the Texas Medicaid Fraud Prevention Act.
Status of case

On October 18 United States District Judge Ron Clark, a GWB appointee, denied PPGC’s request to stop the discovery process.
I spoke with attorney Frank Manion today, of the American Center for Law and Justice, which is handling Reynolds’ case. Manion told me they have just started to receive relevant documents from PPGC.

If PPGC is indeed found to have committed fraud, it will lose all government funding. In fact, the entire nationwide Planned Parenthood chain will be at risk for defunding.
Reynolds is the third whistleblower to accuse her former Planned Parenthood employer of fraud against the government.

Former Planned Parenthood of Los Angeles CFO P. Victor Gonzalez has a case in federal court accusing his employer of similar activity.

And the IRS is investigating charges brought by an unnamed employee of the now defunct Planned Parenthood Golden Gate.

Meanwhile, Americans United for Life reports that government audits have uncovered similar fraud at Planned Parenthoods in New Jersey, New York, and Washington state.

On September 15 Republican Congressman Cliff Stearns, Chairman of the House Subcommittee on Oversight and Investigations, launched an investigation of Planned Parenthood Federation and its 83 affiliates. He can add this information to the pile.

Also Read: Many reasons to INVESTIGATE abortion giant Planned Parenthood – spelled out in gruesome detail!