Breaking: 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.
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.
[Photo of Durkin/Houston PP via the Houston Chronicle; photo of Richards/Durkin via 2onthebeat]
![Related Posts Plugin for WordPress, Blogger...](http://www.linkwithin.com/pixel.png)
What do you expect from a group that makes all their income from killing the innocent? I’m praying and fasting for PP to be de-funded. Join us in prayer in front of PP, please!
Thanks be to God
Health care assistants do not have access to medical billing information so they would have no way of knowing what was billed or not. As for the memos and training, it sounds like they are training to minimize the out of pocket cost to low income clients by billing as much as possible to federal funds. It says right in the complaint that abortions were not billed to federal funds but the aftercare was. That sounds Hyde compliant to me.
My guess is that this complaint will get no traction with anyone except those who want to use it to make political points.
On a personal note, WHO CARES! The government should be paying for every Americans healthcare full stop. Really how great can a society be if they cannot even take care of their elderly and infirmed?
biggz – young healthy women with healthy pregnancies who just feel they “aren’t ready” are neither elderly nor “infirmed” (the word is infirm, by the way) – and abortion is not health care – what makes you such an expert on the responsibilities of the assistants at PP anyway? are you a baby killer yourself? or are you just running your mouth about something you do not really know?
Bless this lady for not being silent but for coming forward! This is outrageous. I can’t wait for the day our government pulls parasitic PP out of their behind and cuts them off once and for all. This evil organization will crumble and some day our descendants will wonder what took us so long to wise up.
Biggz: government should pay for everyone’s healthcare, huh? Congress is completely exempt from the controls they’ve placed on the rest of us little people subject to Obamacare. That fact, more than anything else in that 2,400-page monstrosity, should tell you what they think of their own bill.
How about a few more juicy facts? The Secretary of HHS will have direct access to our checking accounts, can deduct payments any time they want, and they decide who gets what kind of care. For example, if you are over 75, you get no treatment for cancer. Try googling Judge David Kithil on Obamacare and see his list of all the wonderful “care” we’re going to get.
And if you think the individual mandate will work, think again. This tax is anything but individual. It’s the first tax not based on producing or consuming anything. As a single-income family supporting 4 children and an unemployed spouse, I will be paying 6 times the taxes–on one, dwindling income. I prefer the more accurate term, the breathing tax.
This is pure socialism. The worst part is, every egomaniacal politician out there is stupid enough and arrogant enough to think that if only we put them in charge so they can implement their pet schemes, socialism will magically start working and everyone will live in the perfect utopian society. Obamacare is the resurrection of the USSR, complete with full government control of everybody and everything. Socialism is all about controlling people, and Obamacare is the most socialist scheme invented since Lenin. Enjoy your “free” healthcare.
Well, well. PP caught in an overt and calculated act of dishonesty! Surely that is news to the people in Aurora Illinois where PP created a front company called Gemini to build what they told the city would be a “white envelope” facility that would house only profit oriented medical related businesses. But the workers who were installing bullet proof windows suspected otherwise and contacted certain pro-life leadership with their suspicions. Shortly thereafter the cat was out of the bag. Aurora officials were at a loss to explain how they were duped, but by then it was too late. PP announced they were proud of the scheme and had engineered it every step of the way.
Anyway, the point of the above is to show that PP makes its way in the world through covert acts of dishonesty. And, oh yes they also kill millions of unborn babies…but that does not trouble the law. Pilfering a few rubles from government coffers however is another matter.
Biggz says:
“Really how great can a society be if they cannot even take care of their elderly and infirmed?”
Puleeze! Of course we are certain that you will be leading the charge against euthanasia.
LifeletterJ:
Great stuff!
Biggz, I care. I don’t want the government paying Planned Parenthood to kill babies, especially if they have to break the law to do it.
Not too surprising, considering the lack of conscience it takes to work at a PP to begin with. May they continue to be exposed for who they are and what they do. May the people wake up and demand that not one more taxpayer dollar be allowed to fund PP. Let them be funded by their own supporters, like the pro-life movement is.
Planned Parenthood is falling! Is falling!
It may take longer than an hour. But soon they will have fallen. And they won’t be able to get back up!
The monster that is Planned Parenthood is a sinister profit-driven machine that has a deeper, darker core threatening the very soul of our culture. We must continue to flood the marketplace with these kind of stories in an effort to inform our sleeping society about PP’s agenda.
I hope PP is defunded across the board. I would like to see this money re-allocated to REAL healthcare.
Amen, Erin B.!!!
I am praying that state by state PP is defunded!!
DUN DUN DUN DUN!!!
DONE DONE DONE DONE!!!
“Be on your guard against the yeast of the Pharisees, which is hypocrisy. There is nothing covered that won’t be uncovered, nothing hidden that won’t be made known. Therefore, whatever you have said in the dark will be heard in the light, and what you have whispered in an ear in private rooms will be proclaimed on the housetops” Luke 12:1-3
God is shining the light on the hypocrisy of Planned Parenthood. This scripture jumped out at me 4 years ago and I have been praying it over PP ever since! Now, it is coming true! I pray the charges stick! and PP is revealed for who they really are..a modern day motherhood destroyer and baby killing machine!
Biggz, you are so out to lunch. It sounds like what PP is doing is trying to pad their pockets. They are already receiving government funds, and are not satisfied. The problem with what they are doing is it’s deceptive and… IT’S ILLEGAL!!
You say “Who cares??” I CARE!! And so do most others. If you haven’t figured it out yet, anything the government pays for comes out of every ones pocket. You and me included. And I should not have to pay for your birth control or abortions. You want to have choice, yet you want to FORCE me to pay for your choices, including that of killing babies!
And this is not the elderly or infirm we are talking about. We are talking about fertile women usually under the age of 45. And primarily young fertile woman ages 16-30, who just aren’t being sexually responsible. Which is why we have the high rates of teen pregnancies, abortions, and STD rates.
My local PP was found guilty of bilking state medicaid funds, too. They never admitted any wrongdoing, just “accounting mistakes”!
Lynn,
Amen and amen!!
Abortion is child sacrifice. It is satan’s covenant with death.
“And they overcame him because of the blood of the Lamb and because of the word of their testimony, and they did not love their life even when faced with death. Revelation 12:11
Not that our chronic abortion fans have that much credibility to begin with, but whatever shred of decency Biggz might have been capable of expressing is pretty much null and void now. The crimes that Planned Parenthood has been committing should make defunding them a bipartisan no-brainer. Even pro-choicers should be outraged that their darling PP is making them all look so bad. But no, here we have it, in a day when our goverment spending is such a huge issue, an abortion fan is so enamored of Planned Parenthood that he just doesn’t care if they work to bankrupt our state and federal governments. Just doesn’t care. It reminds me of all the abortion fans who just didn’t care about Kermit Gosnell. Death. Crime. Stealing money. As long as babies die, the abortion fans just don’t care. Abortion is a dreadful sickness from which our world needs to heal.
All of the pieces are coming together now. According to Planned Parenthood’s website, the Bryan location is one of the branches of the Gulf Coast affiliate:
http://www.plannedparenthood.org/gulf-coast/locations-hours-33248.htm
This was where Abby Johnson worked before she resigned and became pro-life:
http://abcnews.go.com/Health/MindMoodNews/planned-parenthood-clinic-director-joins-anti-abortion-group/story?id=8999720#.TrLjgnFx_hE
Abby Johnson’s detractors often note that she was put on a performance improvement plan prior to her resignation, and that the records received by the state health department don’t list an ultrasound guided abortion performed the day she said she had her conversion experience:
http://feministsforchoice.com/abby-johnsons-story-doesnt-hold-water.htm
But these new revelations fit perfectly with Abby Johnson’s testimony, as they match both her claims and the records available. They indicate that Planned Parenthood sometimes under-reports abortion (explaining the discrepancies in the health department records) and that clinic directors who don’t bring in enough revenue are pressured to bring in more.
This wouldn’t be the first affiliate whose records were found questionable:
http://liveaction.org/mona-lisa/indianapolis-in-is-planned-parenthood-underreporting-abortions
I bet this is only the tip of the iceberg.
Navi, I’ve never met a single “abortion fan” that didn’t care about Kermit Gosnell. Did this happen somewhere that I can read the comments?
What you guys seem to misunderstand is that the two sides see things differently. If something similar happened at a CPC you would be quick to discredit the source, quick to claim that “this just doesn’t happen at your CPC”, and quick to claim that even if it did… who cares? Wasn’t there a post or comment a few days ago about CPCs forcing religion on their non-religious clients and the general sentiment was “who cares?” Well for anyone that isn’t Christian, I’m guessing they care. This doesn’t make it “fact” that all CPCs are terrible just like it doesn’t make it “fact” that all Planned Parenthood locations are terrible.
If a person doesn’t see abortion as wrong and does believe that it should be a government provided service (along with all other healthcare) then of course they won’t see anything too egregious about this. That doesn’t mean “their credibility is shot”… it just means they’re standing by what they believe in.
You can check Jill’s archives for comments about Gosnell. The most egregious of the not-cares was the NAF who, despite thier OWN photographic and written evidence of Gosnell’s unsanitary conditions, deliberately did not report him because they did not want to endanger abortion’s ubiquitous availability. In my personal experience at the Walk for Life, I got in a short dispute with an abortion-advocating counter-protester who simply pronounced “there will be more clinics like Gosnell’s if abortion is made illegal” with absolutely no sympathy for the women who died or were hurt. I also saw the same sentiment on other blogs and articles on the internet.
Now, if I worked at a dental office that was padding their income with not-done procedures and other assorted and sundry misdeeds, nobody would be arguing that said dentist was merely providing quality care and so what? If it were a dentist, there would be demand for accountability.
When it comes to abortion, there is nothing that is not tolerated. How egregious do abortionists have to be? Can they fudge financial records? You and Biggz say yes. Can they murder born children with a pair of rusty scissors? Well, can they? How bad would things have to be? Even in the case of China’s forced abortions, we have right here on this blog a commentor who constantly defends the policy since it is the law of the land and ‘those women knew what was going to happen to them if they broke the law by getting pregnant.’
Is there any crime or misdeed at all that would make an abortion advocate blush? Apparently not. Neither Biggz nor Elizabeth has convinced me or any other “you guys” that abortion advocates have any credibility whatsoever. None.
ninek, you’re misunderstanding me completely. I never said I was an abortion advocate – I’m simply pointing out that there are two sides and each side obviously believes they are right. That doesn’t make your side any more right, and it doesn’t make their side any more right.
I would say that “there will be more clinics like Gosnells if abortion is made legal” is caring about the Gosnell tragedy. They were not in support of Gosnell, correct? They don’t want terrible things like that to keep happening, correct? I’m sorry if you felt they didn’t mourn the women properly but I’m guessing that it was a short conversation and you didn’t ask them if they cared about those women – I’m sure they would have said that they do.
Neither Biggz nor Elizabeth has not convinced me or any other “you guys” that abortion advocates have any credibility whatsoever. None.
They just keep proving that they are okay with crime of all types.
Everyone, I’d like you to observe this fine example of Relativism:
ninek, you’re misunderstanding me completely. I never said I was an abortion advocate – I’m simply pointing out that there are two sides and each side obviously believes they are right. That doesn’t make your side any more right, and it doesn’t make their side any more right.
Either 2 + 2 = 4 or it does not.
Either water is wet or it is not.
Either abortion destroys a living human being or it does not.
If I hold a book of matches in my hand, I agree it has the potential to become a fire. But if I hold a lit match in my hand, guess what? It’s on fire.
Planned Parenthood is a fraud and should immediately be defunded. They cry “women’s right to choose” all the while bilking the government out of millions/billions of dollars. What a joke…and the women don’t even know they are being used…they actually think these people care about them. For PP it’s all about getting the big $$$$. Time to put them out of business for good.
Elizabeth – something like this cannot happen at a CPC – they do not bill the government for their services, they actually do not make any money. I think a concrete example would be beneficial here if you have one. You are claiming perceptional bias which does lead down the self defeating road of moral relativism. By saying that there are 2 sides to every story I can ask you about your story about the 2 sides of that story – are you biased when you are saying that because that is your perception and you believe the 2 sides to every story? Is the 2 sides to every story just your opinion?
The abortion community and the affiliations that some abortion associations had with Gosnell were severed after his arrest. The abortion community has been quick to distance themselves from him and rightly so. What Gosnell did not only makes the abortion advocates look bad (just as Tiller’s murder did for pro-life) but it is also happened to cross the boundaries and out right murdered what they call “human” (again just like Tiller’s murder but it crossed WAY into those boundaries). I am not sure what your point here is with this information and why you are quick to dismiss ninek as having a quick question and implying that he is uncaring.
When you say: “If a person doesn’t see abortion as wrong and does believe that it should be a government provided service (along with all other healthcare) then of course they won’t see anything too egregious about this. That doesn’t mean “their credibility is shot”… it just means they’re standing by what they believe in”. The author of the blog obviously believes that abortion is wrong – but you seem to have missed the issue or avoided- whether abortion be wrong or right can they lie about the reporting of it? There are laws that those facilities have to follow (just as CPC’s have to follow reporting laws and should not be exempt) when reporting and billing. Abortion is legal and they are legally doing it but what about the other laws? Do they not have to follow them because they are abortion providers? Is that what they believe in? Is it too much to ask them to keep accurate records and bill the tax payer correctly?
and to Biggz – having worked in a medical office as an assistant there are many instances where you will help co-workers in their duties. I often helped the office manager with billing and insurance, sometimes that was all I did all day. So there is a pretty good possibility that she would have had access to that information. And you’re right companies would try and get the government to pay for as much as they could before looking elsewhere, this is a common business practice. But a part of the allegations is that some of these services were not rendered (meaning they were not actually done at all) and that there was some falsifying about what was billed. So that is where the problem lies.