Archive for Office of Inspector General

More audit records reveal overbilling and potential fraud at Planned Parenthood

Posted in Medicaid Billing Practices, Planned Parenthood Audit, Planned Parenthood Medicaid Contract, Planned Parenthood medicaid fraud with tags , , , , , , , , , , , , , , , , , , , , , on October 15, 2017 by saynsumthn

|  (From Live Action News)

Previous Live Action News reports have documented Planned Parenthood‘s history of potential fraud in light of half a billion tax dollars being entrusted to the abortion corporation annually. Watchdog organizations like Alliance Defending Freedom and the Charlotte Lozier Institute have published reports showing Planned Parenthood’s blatant disregard for regulations regarding Medicaid dollars.

In addition to those reports, here are more cases involving the misuse of Medicaid reimbursements by the abortion corporation:

1) Kansas

On January 23, 2017, Planned Parenthood Great Plains and Comprehensive Health of Planned Parenthood Great Plains Kansas (PGP) agreed to pay more than $18,800 for “allegedly violating the Civil Monetary Penalties Law,” according to a report published by the Office of Inspector General (OIG). According to the OIG, PGP submitted claims to Medicaid where the services were:

  • provided by advanced registered nurse practitioners (ARNPs) but were billed improperly under a supervisory physician’s name and national provider identifier
  • provided by ARNPs who were not properly enrolled or credentialed under the Medicaid program and were billed improperly under a supervisory physician’s name and national provider identifier

2) North Carolina

In 2016, the OIG reported that Planned Parenthood Health System, Inc., incorporated in North Carolina, agreed to pay nearly $1.6 million for potentially violating the Civil Monetary Penalties Law. This case involved violations Planned Parenthood disclosed to the OIG; several states were involved, including North Carolina, South Carolina, Virginia and West Virginia. The OIG found that Planned Parenthood submitted claims to Medicaid programs. Billing errors were:

  • services billed under a provider number different than the medical professional who provided the service
  • billed for services of non-physician practitioners who were not properly enrolled in their state Medicaid program

3) Michigan

An audit report of Planned Parenthood and Mid South Michigan, conducted by the Michigan Department of Community Health (MDCH) in 2013, found that Planned Parenthood claimed too much for their CEO’s salary, overcharging MDCH in the amount of $3,358. In addition, the audit noted that Planned Parenthood misclassified expenses, something Planned Parenthood defended as a “spreadsheet error.”

4) New Jersey

A 2008 Office of Inspector General report in New Jersey reveals that Planned Parenthood believes all the services they provide pertain to family planning, and thus warrant a Medicaid reimbursement, when this is not the case. The report states in part:

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.

5) New York

A 2008 audit by the Office of Inspector General in that state, which found that providers incorrectly coded the 90 Medicaid claims by marking “Yes” in the family planning indicator field, said in a footnote:

Officials at Planned Parenthood providers stated that they believed that nearly all the services they provide are related 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.

In 2011, the State of New York, Office of the Medicaid Inspector General, sent a letter to Planned Parenthood of the Hudson Peconic, requiring restitution of overpayments of nearly $31,000 after reviewing claims with payment dates of January 2006 through December 31, 2008.

A New York State Office of Medicaid Inspector General audit of Planned Parenthood Hudson Picnic, published in 2011, reviewed HIV counseling paid from July 1, 2004 through June 30, 2007, and found that nearly $2,227,000 was overpaid but only repayment of just over $2 million was required. Out of a random sample of 100 services the IG reviewed, 83 had at least one error and did not comply with state requirements; a number of those contained more than one deficiency.

 

These examples are yet more proof that serious oversight is needed to guard the millions of tax dollars being sent to the nation’s largest single abortion provider every year. Planned Parenthood’s history of fraud even extends to violations with the federal 340B Drug Discount Program, previously reported here at Live Action News and at Townhall.

Despite this evidence, and after years of politicians promising to defund this abortion behemoth, Planned Parenthood is again poised to receive another half a billion taxpayer dollars in 2018.

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

Planned Parenthood has been cited for Medicaid fraud… so why is it still getting taxpayer funding?

Posted in Medicaid abortion, Medicaid Billing Practices, Planned Parenthood medicaid fraud with tags , , , , , , , , , , , , , , , , , , , , on October 13, 2017 by saynsumthn

|  (From Live Action News)

Planned Parenthood has been cited for overbilling abuses and Medicaid fraud, for violating patient privacy, and for failing to report child sexual abuse. So why is the abortion corporation still receiving half a billion dollars a year from taxpayers?

A study by the Government Accountability Office (GAO) and Congressional Budget Office (CBO) in 2012 showed that Planned Parenthood received $400.56 million in Medicaid reimbursements (including both federal and state dollars), according to findings published in 2017 by the Congressional Research Service. Planned Parenthood’s own 2015-2016 annual report shows that 41 percent of its funding comes from the taxpayer ($554.6 million). Numbers published in previous Planned Parenthood annual reports indicate its affiliates have received more than $4.5 billion from taxpayers.

Taxpayer funding to Planned Parenthood at 41 Percent (image: PP’s 2015-2016 annual report)

Yet, with so much tax money at stake, exactly what kind of oversight is being conducted to safeguard more than half a billion tax dollars entrusted to Planned Parenthood annually?

According to reports by watchdog agencies, very little.

In 2014, the group Alliance Defending Freedom (ADF) published a report identifying 10 types of waste, abuse, and potential fraud Planned Parenthood affiliates have been caught committing or have been credibly accused of nationwide. The potential fraud includes billing while obtaining reimbursements from Title XIX agencies for medications and/or services provided in connection with an abortion. This is illegal.

ADF’s research found that taxpayers were losing millions of dollars in the forced funding of Planned Parenthood, which now garners 35 percent of the abortion market; it is the nation’s largest single abortion provider. Despite several incidents of overbilling and potential fraud, ADF found that only “fourteen affiliates, or approximately twenty-one percent had been audited,” noting that the others “have been accused of financial fraud and worse.”

Planned Parenthood Medicaid Fraud (image credit 2017 Profit No Matter What report)

Then, in 2017, a coordinated study conducted by both the Charlotte Lozier Institute (CLI) and Alliance Defending Freedom reviewed a number of additional audits from a variety of agencies. The purpose of the study was to identify waste, abuse, and potential fraud by Planned Parenthood among its now 57 separately incorporated affiliates, and other abortion and family planning facilities, particularly with respect to federal and state Title XIX-Medicaid programs.

The 2017 Report on Publicly Available Audits of Planned Parenthood Affiliates and State Family Planning Programs identified several cases of unlawful billing, including “[b]illing in excess of actual acquisition cost or other statutorily approved cost for contraceptive barrier products, oral contraceptives, and emergency contraceptive-Plan B (i.e., § 340B drugs) products”:

A large and growing number of federal and state audits have documented that improper practices by Planned Parenthood and state family planning agencies have already resulted in losses to the American taxpayer of nearly $132.4 million, at a minimum, in Title XIX-Medicaid and other healthcare funding programs.

Out of 51 audits, the CLI/ADF report found, “numerous improper practices resulting in significant Title XIX-Medicaid overpayments of more than $8.5 million to Planned Parenthood affiliates for family planning and reproductive health services claims….”

The report notes that “[…] auditors and investigators have specifically identified Planned Parenthood affiliates as the source of at least $12.8 million in waste, abuse, and potentially fraudulent overbilling and penalties…” and that “[t]hree federal audits specifically identify Planned Parenthood – and only Planned Parenthood – as the problem in state family planning program overbilling,” the report states.

The groups pointed out that the audits they reviewed were limited in scope, suggesting the possibility for millions of additional taxpayer dollars to be wasted or fraudulently overbilled.

READ: New report exposes millions in taxpayer fraud at Planned Parenthood

“For example, an audit may examine only one type of billing, for one type of product, for one clinic in a single year. Yet nearly every known audit of Planned Parenthood affiliates and of state family planning programs has found overbilling,” the report notes.

But of the 51 known “recent external audits or other reviews” of Planned Parenthood affiliates’ financial data and practices in 12 states, CLI and ADF uncovered at least $8.5 million in waste, abuse, and potential fraud in the following states:

  • California (two audits of two affiliates): $5,213,645.92 30
  • Connecticut: $18,791
  • Illinois: $387,000
  • Louisiana (two audits of one affiliate): $6,147.18
  • Maine: $33,294.83
  • Nebraska: $3,537
  • New York (seven audits of four affiliates): $1,615,083.25
  • Ohio: none found
  • Oklahoma: unknown, but the overbilling rates have been documented as 14.1%, 18%, and 20.3%
  • Texas (two audits of two affiliates): $538,703.10 -$658,735.97
  • Washington (three audits of two or three affiliates):$640,595.88
  • Wisconsin (27 audits of one affiliate): $95,466.04

Interestingly, the audit from Nebraska proved, as Live Action News has stated many times, that federal and state taxpayer dollars are funding abortion. The report found in the Nebraska audit “a Planned Parenthood affiliate spending federal funds on abortion expenses in violation of federal and state law.”

“In New York, alone, during one four-year audit period, it appeared that hundreds of thousands of abortion-related claims were billed unlawfully to Medicaid,” ADF’s Mattox told a Congressional hearing on the topic in 2015.

Live Action News has previously documented how taxpayer dollars are funding abortions, and Nebraska was just one example. When government funds abortion, more abortions happen, not fewer. This should never be taxpayer funded:

The potential fraudulent use of Medicaid dollars by Planned Parenthood also caught the attention of Oklahoma’s then-Governor Mary Fallin, who sent a letter to the head of the Oklahoma Health Care Authority Board, stating, “[…] more than one in every seven bills submitted for payment to your agency by these providers are inaccurately coded or insufficiently documented…. The lack of attention to the requirements imposed on a responsible provider is a continuing problem for these Planned Parenthood affiliates.”

“As a result of these patterns of irresponsible business behavior among and between the Planned Parenthood organizations,” Fallin wrote, “a dozen states have denied or withdrawn funding to Planned Parenthood affiliates.”

The researchers concluded that despite receiving billions of dollars from taxpayers, only 19 of Planned Parenthood’s 57 U.S. affiliates (33 percent) have been audited, “And others have been accused of financial fraud and worse.”

During testimony in 2015 before Congressional members, Mr. Mattox explained:

[The] Medicaid statute provides grounds for which the U.S. Department of Health and Human Services, in its discretion, may exclude a provider. These include claims for excessive charges, unnecessary services, or services which fail to meet professionally recognized standards of health care; fraud, kickbacks, and other prohibited activities; entities controlled by a sanctioned individual; failure to disclose required information, supply requested information, or supply payment information; sanctioned individuals controlling an entity; and making false statements or misrepresentations of material fact.

He then pointed out:

[…] Planned Parenthood is unlike many other Medicaid providers. Not only has it had great financial success as a Medicaid provider, but also it has been able to avoid much of the oversight and/or corrective action that most Medicaid providers would expect and have received.

Mr. Mattox then alluded to the reason: “… [B]etween local affiliates and the national organization, Planned Parenthood has spent many millions of dollars to support the election of its preferred candidates.”

In 2018, despite large sums of taxpayer dollars being previously misused and few Medicaid audits underway to safeguard additional tax dollars, Planned Parenthood is poised to receive yet another half a billion forced taxpayer funding. This, despite repeated promises by GOP Senators, members of Congress, as well as President Trump, to defund Planned Parenthood — which has not yet happened, despite the fact that Planned Parenthood’s legitimate health care services and patient numbers have been declining for years:

The continued misuse and fraud of American tax dollars by Planned Parenthood is unacceptable. When will it stop?

Read the full report detailing Planned Parenthood’s potential fraud and waste of taxpayer funding here.

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

Planned Parenthood misbilled Medicaid in New Jersey, reports claim

Posted in Abortion, Planned Parenthood with tags , , , , , , on August 16, 2010 by saynsumthn

On the heels of a California Planned Parenthood loosing it’s national affiliation for misappropriation and mismanagement of funds”
( READ: Should there be an investigation into tax funded Planned Parenthood clinics? Letter reveals PPGG’s “misappropriation and mismanagement of funds”)

New Jersey Right to Life has issued this disturbing press release about New Jersey Planned Parenthood’s

Contact: Marie Tasy, Executive Director, 732 562 0562

PRESS RELEASE � August 13, 2010

U.S. INSPECTOR GENERAL AUDIT REPORTS SHOW IMPROPER BILLING OF FAMILY PLANNING SERVICES IN NJ

Audits performed by the U.S. Inspector General for the Department of HHS uncovered a consistent problem with NJ family planning clinics improperly billing Medicaid for services that did not qualify as family planning. State officials were sent letters in July 2007, June 2008 and August 2008 notifying them of the problems and requesting action to correct the errors. The three reports covered the period from February 1, 2001 through January 31, 2005. The first audit identified that the state of New Jersey improperly received federal reimbursement at the enhanced 90% rate for 160,955 prescriptions drug claims that were billed as family planning, but did not qualify as family planning services. In the letter and accompanying report to Commissioner Velez, the Inspector General recommended that NJ repay $2,219,746 to the Federal Government.

The second audit by the U. S. Inspector General for the Department of HHS found that family planning clinics improperly received the enhanced 90% rate for outpatient services which did not qualify as family planning services. Of the 107 claims, 64 were for family planning services eligible for Federal Medicaid reimbursement at the 90 percent rate and 43 claims did not qualify as family planning services, and were therefore ineligible for Federal Medicaid reimbursement at the 90% rate. The report specifically cites Planned Parenthood Providers who told investigators that they billed all claims to Medicaid as family planning and populated the family planning indicator field on Medicaid claims even though the service provided did not meet the criteria for 90 percent Federal funding. As a result, a letter and the report was sent to the Commissioner of Human Services on June 17, 2008, by the Office of Inspector General recommending that the state refund $597,496 to the Federal Government and amend their procedures to prevent improper billing in the future.

The third audit found that the state of NJ received Federal Medicaid reimbursement for 111 of the 161 claims for inpatient services which were improperly billed as family planning at the enhanced 90 percent rate. As a result, the OIG recommended that the state of NJ reimburse $162,548 to the federal Government and determine the amount of federal Medicaid funds improperly reimbursed at the 90% rate for inpatient hospital services following the audit period and refund that amount to the Federal Government.

The facts cannot be denied. These audits show a systematic abuse of improper billing of Medicaid for family planning services to the federal government to obtain 90% reimbursement. Planned Parenthood has been cited specifically as one of the principal agents of these improper billing practices by the OIG. Page five of the 2008 report entitled, Review of Outpatient Medicaid Claims Billed As Family Planning by New Jersey” says, 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. Therefore, officials at these clinics often populated the family planning indicator filed 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. The Office of Inspector General recommending that the state refund $597,496 to the Federal Government.

Planned Parenthood’s supporters not only want to use $7.5M in taxpayer dollars to fund these family planning clinics, they also want the state of NJ to permanently apply for a federal waiver to reimburse family planning clinics 90% for every Medicaid service they provide despite the clinics history of improperly billing Medicaid and contributing to the nearly $3M in fees which had to be refunded to the Federal Government. Taxpayers should be outraged. These facts should give every legislator who voted for Bill S2139 a good reason to now oppose any misguided effort to override Governor Christie’s veto.

Reports can be found here:

1 http://oig.hhs.gov/oas/reports/region2/20501019.pdf

2 http://oig.hhs.gov/oas/reports/region2/20601010.pdf
3 http://oig.hhs.gov/oas/reports/region2/20601020.pdf

_______________________________________________________________________________________________________________________

Also Read this story Audit Shows Planned Parenthood Owes Thousands, sources say debt stands at $1 million

Planned Parenthood Owes $154K To UMC
November 13, 2009
EL PASO, Texas — KFOX has confirmed Friday that Planned Parenthood Center of El Paso owes more than $150,000 to the county’s University Medical Center.

Through an open records request, KFOX has learned that PPCEP owes UMC $154,814. Sources close to PPCEP claim their total debt stands at more than $1 million.

University Medical Center declined any comment on PPCEP’s current balance. They did not disclose what type of contract was established.

As KFOX reported, a state audit found that PPCEP violated its state contracts after it requested reimbursement for bills that were never paid.

State representatives have told KFOX that it is unclear if the money will ever be collected, and PPCEP is currently under bankruptcy protection.

KFOX has not been able to confirm PPCEP’s bankruptcy status

View Story Here:

Inspector General Report Here