Tag Archives: Karen Reynolds

BREAKING: Third Medicaid fraud lawsuit emerges against Planned Parenthood Gulf Coast

breakingA third lawsuit has emerged accusing  Planned Parenthood Gulf Coast of committing Medicaid fraud.

Former PPGC accounts receivable manager Patricia Carroll is alleging her former employer falsified Medicaid claim forms and double billed.

Carroll joins former Planned Parenthood Gulf Coast employee Karen Reynolds, who won her case in 2013 and received a $1.25 million bounty from the $4.3 million settlement paid by PPGC to Obama’s Department of Justice, and former PPGC employee Abby Johnson, whose lawsuit accusing PPGC of $6 million in fraud is still pending.

Carroll originally filed a sealed whistleblower lawsuit in 2012, but at some point the case was unsealed, coming to light on May 19 when she filed an amended complaint.

Carroll alleges Planned Parenthood’s Huntsville clinic staff ran a Medicaid fraud scheme between 2002-12 involving troubled teens involuntarily remanded at Gulf Coast Trade Center in New Waverly, Texas.

Nonphysician staff from Planned Parenthood routinely drove to the center to take two separate blood draws for STD and HIV testing 10 days apart from newly detained youths, when one blood draw would have sufficed. Planned Parenthood then filed Medicaid claims falsely indicating the blood draws were completed at its Huntsville clinic on two separate visits and by a physician.

Carroll’s lawsuit alleges PPGC “is an ineligible provider of Medicaid services in a school or prison setting.” So, she states, PPGC Huntsville staff created false charts and false office appointments to cover up the scheme. Furthermore, Carroll alleges Trade Center violated the HIPAA privacy rule by providing identities and Medicaid numbers to Planned Parenthood.

Carroll further alleges the blood tests were unnecessary to begin with, since the youth were medically screened before coming to the center.

Carroll says she became suspicious when Planned Parenthood’s Huntsville clinic suddenly showed a 315% spike in revenue, whereupon she took a closer look at its books.

If Carroll’s allegations prove true, the cover-up extends all the way up to the upper  echelons of Planned Parenthood Federation of America.

After Carroll discovered the illegal revenue stream, she first approached local PP managers to no avail and finally called PPFA’s corporate office in New York, which forwarded her to PPFA’s ethics attorney, Jay Meisley, in Washington, D.C.

Meisley referred Carroll to a local attorney, with whom she understood she would be filing an ethics complaint. But that attorney, “presumably Alissa Rubin,” according to the lawsuit, turned out to be Planned Parenthood’s own attorney defending PPGC against Reynolds’ and Johnson’s lawsuit.

Carroll finally quit, refusing to file additional Medicaid claims she thought were illegal.

“Immediately thereafter,” according to her lawsuit, “[PPGC CFO] Jeffrey Palmer, [PPGC HIV Program Director] Susan Rokes and [PPGC VP of Medical Services] Laurie McGill made the decision to write-off the claims Carroll refused to release, but did not, to Carroll’s knowledge, fully inform the Medicaid Program or reimburse fraudulent billings.”

Carroll alleges the fraudulent claims were for approximately $200 each and amounted to “thousands” over the course of a decade.

PPGC garnered great media sympathy by taking the occasion of Texas Governor Rick Perry’s signing of the omnibus pro-life law in 2013 to announce it was closing three of its 12 clinics. 

Not coincidentally, the clinics were in Lufkin, where Reynolds discovered fraud, Bryan, where Johnson discovered fraud, and Huntsville, where Carroll discovered fraud.

Planned Parenthood tried to get Carroll’s lawsuit dismissed by claiming the statute of limitations had run out and that her fraud claims were not specific enough.

On May 14, District Court Judge Sim Lake ruled against PPGC on all its motions to dismiss, except its point that one of Carroll’s claim was not specific enough. In the latter case the judge gave Carroll 15 days to clarify that one allegation, which she did on May 19. The judge noted, “Carroll has adequately pleaded factual content that allows the court to draw the reasonable inference that Planned Parenthood knowingly filed false claims.”

[Thanks to Alliance Defending Freedom attorneys Steve Aden and Casey Mattox for their input]

Poor Planned Parenthood against those evil, greedy whistleblowers

underdog

Poor Planned Parenthood, with its piddly one billion dollar annual income. It’s just no match for evil, greedy whistleblowers, at least according to pro-abort “reporter” Carolyn Jones at The Guardian:

Whistleblowers are the good guys, right? They cry foul on charlatans and overreaching governments. But what if your urge to disclose is lubricated by the promise of a whopping pile of cash? What if powerful lobby groups are standing by to give you first-rate legal representation? And what if your inside knowledge relates to one of America’s most bitter cultural conflicts?

Well, if the prospect of a hefty legal settlement helps persuade you to the anti-abortion cause, then the US False Claims Act, being used to expensive effect against Planned Parenthood providers, might be the law for you.

Jones disdained the fact that former Planned Parenthood Gulf Coast employee Karen Reynolds got a $1.25 million settlement  from the U.S. Obama/Holder Department of Justice, which, Jones did not note, agreed with Reynolds that PPGC committed Medicaid fraud.

No, Planned Parenthood is the underdog, paying off such unmerited lawsuits “rather than endure costly legal battles.”

Nor did Jones like the fact that I promoted Reynolds’ bounty:

And after the size of Reynolds’ bounty became public, influential anti-choice blogger Jill Stanek tweeted every Planned Parenthood affiliate to “tell what u know”. She also endorsed a follower’s tweet that said, “heck, for $1.25 Mil, I’d even tell them what I don’t know”, and she crowed to the ADF that she was trying to drum up business for them.

Commenter ninoinoz nicely summed up all that was wrong with Jones’ piece:

Gosh, I’ve really enjoyed this article.

The Guardian griping against whistleblowers when it’s one of its pet causes being exposed. Julian Assange and Edward Snowden, anyone?

Also, considering abortion is only legal it the United States because of a court decision (Roe vs. Wade), it is LOL funny to complain about legal actions launched by your opponents.

I also like the belly-aching about pro-life groups organising and financing legal action. Are you the only ones allowed to do that then?

Finally, to complain about a pro-life activist using social media (Twitter) to seek out fraud is laughable. Are pro-lifers supposed to only use quills and parchment?

The fact is, whistleblowers could bring Planned Parenthood down. So, of course, they must be pretzeled into being the bad guys.

BREAKING: Bombshells in Parenthood Gulf Coast’s $4.3m fraud settlement

breakingnews2The good people at Alliance Defending Freedom have forwarded me the settlement agreement between Planned Parenthood Gulf Coast and 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 divied 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.

ADF attorney Casey Mattox was kind enough to walk me through the settlement agreement. Following are the high points, including a few bombshells. [Read ADF’s blog on this here.]

Department-Of-Justice6308The most significant component of the settlement is that the U.S. Department of Justice “contends that PPGC submitted false claims and made false statements to the United States in connection with claims submitted to” Medicaid, Title XIX, Title XX, and the Texas Women’s Health Program.

This represents the first time the U.S. Department of Justice has accused aPlanned Parenthood affiliate of fraud.

That it was Barack Obama/Eric Holder’s DOJ makes this even more newsworthy.

The WHP is the very program PP had the audacity to kick and scream about being evicted from last year, when all along at least one of its affiliates was defrauding it.

In the settlement PPGC denies the allegations are true.

But as Mattox  said, “If you believe a Planned Parenthood affiliate that has been fighting against defunding efforts, threatening lawsuits over its exclusion from the Women’s Health Program, has another Medicaid fraud case pending in federal court [Abby Johnson’s], and claims recently passed pro-life legislation is forcing it to close clinics, would pay $4.3 million just to make this case go away, I have depreciating property I’d like to show you. If PP really believed these claims were baseless, this was their chance to demonstrate that in court. Instead, they paid out a huge chunk of money.”

The settlement clearly stipulates both the State of Texas and federal government believe PPGC billed false claims.

Another huge component of the settlement is that PPGC has 90 days to identify overcharges it has made against the government and Medicaid and repay the overcharges, plus interest and penalties.

Other noteworthy points in the settlement:

  • The Inspector General and DHHS reserved the right to investigate other claims against PPGC (Abby Johnson’s lawsuit, for instance).
  • The government (state/federal) reserved the right to sue for civil or criminal liability, including “current or former directors, officers, employees, agents, or sharehoolders of PPGC.”
  • The government reserved the right to audit PPGC’s books for overcharges.
  • PPGC cannot turn around and charge former patients or insurers for government overcharges.
  • PPGC agreed to cooperate with any government investigation and turn over requested unredacted documents and reports. PPGC cannot impair employees from cooperating with the government.
  • If for some reason PPGC reneges on this settlement, such as by declaring bankruptcy, the government will increase the amount PPGC owes to “$6,432,560, which represents three times the amount the Government alleges to have be overpaid.”

The latter point means the government believes it can prove it found $2,144,186.67 million in overcharges by PPGC.

So PPGC’s $4.3 million settlement is for twice that amount. Reynold’s lawsuit alleged PPGC overbilled “several millions of dollars” over the course of six years. Mattox believes the $30 million figure mentioned by news outlets included penalties.

downloadThe amount of waste, abuse, and fraud uncovered in Planned Parenthood affiliates nationwide now totals over $12.5 million, according to Mattox. Auditors and investigators in several states have uncovered Planned Parenthood affiliate fraud.

That the federal government has identified Planned Parenthood as submitting false claims should impact the ongoing congressional hearing, said Mattox, and also help states trying to defund Planned Parenthood.

Mattox said it will be interesting to see the amount of Medicaid funds Planned Parenthood receives over the next 2-4 years. It should be tightening up its act.

We may already be seeing it. RH Reality Check complained today:

[C]laims in [the] Texas Women’s Health Program, which replaced the Medicaid Women’s Health Program at the start of this year, have declined by about 23% in the first five months of 2013, as compared to Medicaid Women’s Health Program claims during the same period last year. This is the first year the program has operated without Planned Parenthood.

RHRC was trying to claim that fewer low income women are being served. But the lower number more likely represents claims not padded by Planned Parenthood.

“It is hard to calculate the impact these lawsuits are having,” said Mattox. They are forcing Planned Parenthood to make voluntary changes in its billing practices.  My biggest hope is this will hurt Planned Parenthood by taking the Teflon off.

“Planned Parenthood knows it now has people looking over its shoulder,” Mattox said. “I can guarantee you PP went into this with the mindset, ‘How much can we bill and get away with?’ Now PP’s mindset is, ‘What can I defend to a judge?'”

Planned Parenthood Gulf Coast actually settled for $4.3 mil, not $1.3 mil, for Medicaid fraud

ppfraud-320x240Texas Attorney General Greg Abbott announced on July 24 that his office had obtained a $1.4 million settlement against Planned Parenthood Gulf Coast for Medicaid fraud, with the settlement to be split between the state of Texas, the federal government, and the whistleblower (former PPGC employee Karen Reynolds).

It turns out the AG was apparently only announcing his state’s cut. The total settlement is actually $4.3 million – almost $3 million more than previously known. From the Houston Chronicle today:

Planned Parenthood’s Houston-based affiliate clarified Tuesday that it settled for $4.3 million, three times the $1.4 million that Abbott reported a week ago.

His spokesman tried to explain the discrepancy, indicating Abbott intended to announce the smaller amount, which represents the “state’s designation.” But it’s unclear why Abbott wouldn’t have announced the whole amount.

The attorney general also jumped the gun with his press release, announcing the settlement before it had been finalized. (It has since been signed by all parties.)

When I called the AG’s press office to help me understand the discrepancy  I was greeted by a inexplicably rude man who wouldn’t even give me his name. His response before hanging up, “It means the investigation is not over.” Ok. Still don’t understand, but there you go.

Despite the confusion this would all seem to be good news, although the original charge was that PPGC “submitted more than $30 million in fraudulent bills between 2003 and 2009,” according to the Houston Chronicle, July 30.

“If the original claim that PP defrauded the taxpayer of $30 million is near accurate, it means that PP settled for 15 cents on the dollar,” wrote American Life League’s Jim Sedlak to me in an email. “No incentive there to stop committing Medicaid fraud.”

Abby Johnson’s lawsuit against the same Planned Parenthood affiliate is still not settled. Abby alleges PPGC committed “over $5.7 million in fraud,” according to her legal representation, Alliance Defending Freedom.

[HT: Jim Sedlak; graphic via ADF]

Massive, systemic Planned Parenthood fraud on brink of exposure?

The backstory, from LifeNews.com, March 12:

Former Planned Parenthood abortion facility director Abby Johnson has filed a whistleblower lawsuit against the abortion business claiming its Texas affiliate knowingly sent in about $6 million in false claims to Medicaid and covered up its actions….

The formerly sealed federal “whistleblower” suit… was made public [March 9] and was filed in 2009 by the Alliance Defense Fund on behalf of Johnson….

The suit alleges that Planned Parenthood knowingly committed Medicaid fraud from 2007 to 2009 by improperly seeking reimbursements from the Texas Women’s Health Program for products and services not reimbursable by that program.

Johnson was the third former PP employee to file fraud charges, joining Victor Gonzalez, who filed a complaint against Planned Parenthood Affiliates of California in 2008, and Karen Reynolds, who filed a complaint last year against the same affiliate as Johnson, Planned Parenthood Gulf Coast.

Since Johnson’s story broke last week, five former Planned Parenthood employees have contacted her to say they realized after reading details of her lawsuit that they, too, may have unknowingly been involved in defrauding the government.

These were lower level staffers who merely followed instructions when completing paperwork. One worked at a PP in California, and the other four worked in new states other than California or Texas.

When we spoke by phone yesterday, Johnson told me she put the former employees in touch with ADF for follow-up.

The growing body of evidence should help fuel the ongoing congressional investigation of Planned Parenthood as well as aid officials in various states in knowing what to look for when reevaluating past years’ Planned Parenthood invoices. While PP affiliates allegedly involved in fraud my stop, they cannot retract paperwork already submitted for which they have been paid and for which they are liable.

Planned Parenthood employees may be peronally liable

Along with the affiliate and parent organization, PP employees involved in committing fraud may also be personally liable, depending on the level of fraud committed and how much requisite knowledge they had.

I spoke with ADF attorney Mike Norton today about personal liability.

“Current or former employees who have information about potential fraud should speak with an attorney for guidance,” said Norton. “I would be happy to talk to anyone who thinks they have knowledge about fraud committed by Planned Parenthood. I want to make sure they are protected as whistleblowers and help reveal the crime rather than become a bullseye of the investigation.”

Contact Norton at 480-388-8163.

(Prolifer)ations 2-17-12

Thumbnail image for blog buzz.jpgby Susie Allen, host of the blog, Pro-Life in TN, and Kelli

We welcome your suggestions for additions to our Top Blogs (see tab on right side of home page)! Email Susie@jillstanek.com.

  • In case you missed it, Vital Signs has the scoop on former Planned Parenthood Gulf Coast employee Karen Reynolds’ lawsuit against her former employer, alleging fraudulent Medicaid billing practices.

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Life Links 2-15-12

web grab.jpgby JivinJ, host of the blog, JivinJehoshaphat

  • Debra Saunders hits on one of my pet peeves in a column on Obama’s mandate:

    For its part, the administration keeps stretching the English language to the brink. The U.S. Department of Health and Human Services frames the issue as one of “access” to “preventive health-care services.” “Access” no longer means being able to obtain something. “Access” now means being able to get something for free and making someone else – even someone who objects on moral grounds – pay for it.

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Texas Planned Parenthood CEO named in Medicaid fraud complaint announces his retirement

It’s a coincidence, right?

After 26 years as CEO of Planned Parenthood Gulf Coast, Peter Durkin has announced he will retire in April 2012.

The timing works out well for Durkin to avoid publicly having to deal with a complaint filed by former PPGC employee Karen Reynolds alleging massive Medicaid fraud.

Reynolds lodged her complaint in July 2009, but it was under seal until this past March and is only just starting to get traction. On October 18 Judge Ron Clark denied PPGC’s request to stop the discovery process, which is now underway according to American Center for Law and Justice attorney Frank Manion, with whom I spoke.

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