Archive for Profit No Matter What

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.

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.

Profit No Matter What report exposes Planned Parenthood’s ongoing taxpayer abuse

Posted in Financial mismanagement, Medicaid Billing Practices, Planned Parenthood fined by state, Planned Parenthood medicaid fraud with tags , , , , , , , , on July 23, 2014 by saynsumthn

Profit no matter whatAlliance Defending Freedom made public Wednesday its latest annual report to Congress that identifies waste, abuse, and potential fraud by Planned Parenthood, state family planning programs, and other organizations. As in 2013 and previous years, the report urges Congress to continue its investigation into the misuse of taxpayer dollars.

“The government should use American tax dollars responsibly and for the common good. The taxpayers who provide that hard-earned money deserve to know if it’s being funneled to groups that are abusing it,” said ADF Litigation Counsel Catherine Glenn Foster. “When it comes to accountability and transparency, Planned Parenthood’s publicly-funded, billion-dollar abortion empire cannot be given a pass. It has to play by the same rules as everyone else.”

ADF Report 2014

The updated report, titled “Profit. No Matter What,” explains that “Planned Parenthood and its affiliates are engaged in a pattern of practices designed to maximize their bottom-line revenues through billings to complex, well-funded federal and state programs that are understaffed and rely on the integrity of the provider for program compliance.”

The report details the 44 known audits or other reviews of Planned Parenthood affiliates’ financial data and practices, as well as 51 known audits of state family planning programs and three known audits of family planning organizations that found overbilling. The audits for fiscal year 2013 found a total of more than $115 million in waste, abuse, and potential fraud in federal and state family planning funding programs, the lion’s share of which goes to Planned Parenthood. Approximately $14.4 billion of federal Medicaid expenditures were improper payments, according to government sources.

The report also identifies 10 types of waste, abuse, and potential fraud Planned Parenthood affiliates have been found to be committing or have been credibly accused of nationwide. The potential fraud includes the illegal practice of billing and being reimbursed by Title XIX agencies for medications and/or services provided in connection with an abortion.

Other alleged billing violations include billing in excess of actual acquisition cost or other statutorily approved costs for contraceptives and Plan B products, inappropriately billing for services that were not medically necessary, billing for multiple initial prenatal care visits, and incorrectly billing initial, follow-up, and postpartum services.