BREAKING: Bombshells in Parenthood Gulf Coast’s $4.3m fraud settlement
The 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.]
The 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.
The 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?'”
Jill Stanek is a nurse turned speaker, columnist and blogger, a national figure in the effort to protect both preborn and postborn innocent human life.
Fraud should be dealt with, regardless of who is doing it. That includes defense contractors such as Lockheed Martin and Halliburton. But, of course, antiabortion zealots aren’t as impassioned about their fraud.
Did Mike Pences’s bill to defund PP of all Title X funds, the one that passed the House in 2011; ever get a vote in a Senate? This would be a good time to reintroduce it
Does this mean that the abortion figures might be inflated as well? If so, that could make it even more tragic for all those women who consoled themselves for deciding to abort by accepting the lie that abortion is commonplace. What if abortion is not as commonplace as PP and the prochoice lobby suggests? What if the many women who walk into the abortion clinic don’t actually follow through and get an abortion? That could mean the actual amount of women who have had an abortion is smaller than everyone suspects. It may mean that these abortion providers are likely pushing a service that they themselves would never use.
I guess you can give up campaigning now then Tyler.
Silly PP. Should have found a judge who supports moving vast sums of money ($57M maybe?) from general accounts to specialised ‘trusts’ so that any claimants get handed an empty bucket; rather than a judge who merely opined “I’m very mindful of the fact that the government (Texas) didn’t think that there was a lot there. They didn’t get themselves involved, so why not go ahead and get this case wrapped up so your clients can go back about their business.”
Lots of ‘contends’ and ‘denies’ in the document.
Looks like being a relator is a lot more lucrative than being a realtor. Might have to look into that.
Merit, please prove that not a single pro-lifer in the history of the world has never made a peep about any other fraud perpetrated anywhere. Thanks.
Ah, Reality, still proving your username as extremely ironical, I see. :)
Hey thought you guys might like to know that an abortion clinic in Toledo OH closed because they didn’t have an emergency contract with a nearby hospital. I guess this hospital wouldn’t take botched abortion patients! Win win pro lifers!!
“Ah, Reality, still proving your username as extremely ironical, I see.” – please demonstrate any lack of veracity or reality in what I said JoAnna.
I shan’t be holding my breath :-)
Also perhaps mods could use this as breaking news tomorrow ….dirty equipment with mold outdated medication sitting around. No transfer agreements with the nearest hospital. Hmmmm haven’t we heard this one before?? Apparently this clinic had been operating since 1983.
“I guess this hospital wouldn’t take botched abortion patients!”
Heather, Not so much that the hospitals wouldn’t take the patients as they wanted to stop the butchers that were sending them there.
“I guess this hospital wouldn’t take botched abortion patients!” – actually the truth is probably that they wouldn’t agree to a contract because there weren’t enough admissions being guaranteed. Or the hospital operates according to doctrine rather than law.
So if there were actually an emergency the hospital would just let the patient die?
Ts hi there! Yes you put it better than I.
As an “antiabortion zealot”, I’m thrilled the truth about PP is being revealed. Yep, the possibility of fewer women and babies being victimized by abortion impassions me in a way that simply stopping fraud doesn’t. Go figure.
Sheesh.
Hospitals won’t accept contracts with doctors who they think are dangerous to patients. This isn’t just abortion-related.
” Hospitals won’t accept contracts with doctors who they think are dangerous to patients. This isn’t just abortion-related.”
I get this but I think I don’t really understand what is going on here. When they don’t have transfer agreements, do they just not allow women who need hospital assistance to be admitted, just because they came from a clinic that they don’t have an agreement with for whatever reason? That seems really unethical and I can’t imagine that a hospital would actually do that, put a patient at risk like that. I must be missing something, not understanding correctly.
“Fraud should be dealt with, regardless of who is doing it. That includes defense contractors such as Lockheed Martin and Halliburton. But, of course, antiabortion zealots aren’t as impassioned about their fraud.”
Or, you know, people care about things directly proportionate to how passionate they are about the subject. I bet a lot of other pro-lifers don’t care as much as I do when unethical animal testing facilities get shut down/investigated, but I don’t whine about that. People have a limited amount of attention to give the world, and it’s not hypocritical or wrong to not care an equal amount about every issue ever in the world. That’s just silly and an ad hominem, I think is the term.
“Hospitals won’t accept contracts with doctors who they think are dangerous to patients.” – I can understand that, so what’s the problem here then?
And again, do they just let those patients die?
Wasn’t Al Capone’s actual downfall tax evasion? As a Christian, I know I’m called upon to be humble..but I can’t help a little “bwahahaaa..”
“As an “antiabortion zealot”, I’m thrilled the truth about PP is being revealed. Yep, the possibility of fewer women and babies being victimized by abortion impassions me in a way that simply stopping fraud doesn’t. Go figure.”
Yes, exactly, that’s why I think people are just deflecting and being silly when they bring up unrelated issues to be like “Hypocrites!!! You don’t care about this!!! Zealots!” Lol of course people who spend their lives trying to protect unborn babies from abortion will be more interested in a fraud case involving one of the biggest abortion-providing organization in the US which might lead to less dead unborn babies, than some defense contractors defrauding something or other. Whatever Merit is going on about. I’m pretty sure people who spend their life fighting for environmental reform are more excited when BP gets in trouble than when PP gets in trouble. For goodness sake.
Admitting privileges mean that the hospital can anticipate the patient(s) imminent arrival, for example, and minutes saved can save lives.
But abortion advocates don’t much care about that. Glad that the cracks in PP’s facade are widening. Swing away.
The clinic was in violation! Did you read where I wrote there was filthy surgical equipment? Lets just sweep that under the rug. The clinic ignored having an agreement with a transfer to the nearest hospital so they had to close…and if there weren’t any botched abortions this would be a non issue…run it through your search engines and get back to me.
“Admitting privileges mean that the hospital can anticipate the patient(s) imminent arrival, for example, and minutes saved can save lives. ”
Well of course pro-abortion advocates are being unethical and wrong by not caring about this, but I think hospitals refusing admitting privileges are being unethical as well if this is true. It’s not okay to put women’s health at risk. Even if you’re 100% anti-abortion completely, I think it’s unethical to put women’s health at risk by refusing to do things that can lessen a woman’s risk of death if there are complications. I don’t think it’s very pro-life, at least.
Its kinda like if airport security decided to let 5 people through security without checking their bags or wanding them down. Its about breaking the rules. The abortion clinic broke many rules hence it is closed!!!
I believe I had read 42 abortion clinics closed and counting. I don’t think Toledo has one anymore.
“Admitting privileges mean that the hospital can anticipate the patient(s) imminent arrival, for example, and minutes saved can save lives.” – what, do those with admitting privileges make anticipatory calls, before any need arises? Are they prescient?
“But abortion advocates don’t much care about that.” – actually it’s the knuckle-dragging politicians like Perry who have shown they don’t much care about that.
“Glad that the cracks in PP’s facade are widening. Swing away.” – don’t panic, it’ll get reinforced.
“Did you read where I wrote there was filthy surgical equipment?” – I read what you claimed.
“run it through your search engines and get back to me” – excuse me?
Does this mean that the abortion figures might be inflated as well?
Sadly, the reverse seems much more likely (at least in the U.S):
http://articles.chicagotribune.com/2011-06-16/news/ct-met-abortion-reporting-20110615_1_abortion-providers-fewer-abortions-national-abortion-federation
http://www.youtube.com/watch?v=cyeqGEbh7ME&list=PLF67287E5C10EB429&index=6
During a non-gyn medical emergency, my doctor called ahead and in the 10-12 minutes it took us to arrive in the emergency room, that staff was able to get ready.
Bucket of duh. Maybe Tonya Reeves could have been saved with perhaps, an HOUR OR TWO more of medical care instead of being IGNORED by the staff SHE PAID to make her abortion ‘safe.’ You abortion advocates have nothing.
And most abortion docs don’t have admitting NOT because of the hospital’s refusal, but because the ABORTIONIST is sub-standard doesn’t even try or qualify.
Obama/Holder are simply showing Cecile who’s in charge now. Shakedowns don’t always have to be directed to the right, and I have absolutely no confidence that the US government is doing the right thing because of any sense of justice.
BTW – just because this particular fraud was revealed, doesn’t mean they haven’t come up with another scam. Sebelius and PPACA is a good place to start looking. Oh that’s right, she’s running her own shakedown…
Has the IRS ever audited abortion providers like Gosnell, etc.? If one lies about the number of abortions one does, would one lie on a tax form? OH, sorry. My bad. A member of the Tea Party would not be an abortionist.
The term ‘admitting priviledges’ is a misnomer to a layperson, it has absolutely nothing to do with either admitting a patient into the hospitals care OR with the doctor calling ahead to ready needed services. Admitting priviledges means that the doctor follows the paitient and retains practice rights. So, for instance (none abortion senario) a CNM have admitting privileges to a local hospital and her home birth patient decides she wants an epidural, so the CNM calls the hospital and admits the patient as *her* patient, following along and continues to provide care for the patient in the hospital. Contrast that to a CPM without admitting privileges who has a home birth patient who decides she wants an epidural. The CPM can still call ahead to the hospital and inform L&D, can still show up with her patient and hand over medical records to the hospital doctor, but she can not ‘practice medicine’ once on hospital grounds. Admitting privileges are for continuity of care, the same doctor following from start to finish, which is very good for patients because less time is wasted ‘catching up’ on what’s going on and medical history, and their is typically less stress involved for the patient, who continues to be under the care of a doctor (s)he trusts. But it’s also about liability, if a hospital allows admitting privileges than they are taking reponsibility for that doctor’s practice on the hospital premise, they are responsible as a legal entity attatched to the doctor, which means they require specific medical standards such as continuing education, board certification, malpractice insurance, good work history, etc. Under most circumstances the hospital requires admitting doctors also work for the hospital for a certain number of hours every month, not that they have a certain number of transfers, which no doctor can guarentee. Abortionists can’t get admitting privileges not because hospitals don’t want to take care of botched victims, they do that anyway, not because they don’t want prompt treatment, records, and continuity of care, but because the abortion doctors are unable or unwilling to reach the minimum requirements for privileges such as those listed above. This is both because abortionists have long been known as the bottom of the barrel skill-wise and because they refuse or are unable to practice anything other than abortions to meet working relationship requirements. Most of the stories presented in the last few years about abortionists not being able to get admitting privileges have been because the abortionists is unwilling or unable to become board certified, they refuse to stay in-town a specified number of hours for hospital work, or they lack malpractice insurance.
Jespren: Thank you for explaining that so I didn’t have to sit here and type it all in. That is exactly right.
And no, DUH, if a patient shows up in the ER then they have to be treated regardless of what they came in for, their insurance status, or who the doctor was. They don’t “just let them die”. Good heavens. Way to be melodramatic.
Despite the mountain of evidence to the contrary, Reality, you still believe PP is utterly innocent of any fraud. That’s the irony, “Reality.”
Another example of irony: “And again, do they just let those patients die?” Perhaps in your fantasy world that happens, but in actual reality, we have EMTALA (http://www.emtala.com), so no patients “are left to die” regardless if the abortionist who nearly killed them has admitting privileges or not — of course, that’s assuming they get to the ER in the first place and aren’t directly instructed not to go there, as Carhart is so fond of doing.
This is a 7.5 on the Richter scale for PP…Devastating quake! Praise God!
No JoAnna, the irony is that I haven’t said PP is utterly innocent, I’ve simply pointed out the facts of the whole situation rather than launch into exaggerations and extrapolations.
I asked a question. I didn’t make a statement. Therefore no fantasy was required, not on my behalf anyway.
“This is a 7.5 on the Richter scale for PP…Devastating quake!” – barely a tremor.
I get this but I think I don’t really understand what is going on here.
What’s going on is that the state of Ohio passed an omnibus bill that both required abortion clinics to have hospital transfer agreements and forbade public hospitals to make transfer agreements with abortion clinics. Why? Because they could not possibly care less about “continuity of care.”
I guess the nearest admitting hospital would be in Michigan…..much too far away so the clinic closed.
Did you guys notice reality the troll glossed over the unsanitary molded equipment? Typical …just go ahead and let women die from infection. No getting through to anyone who wants to gloss over facts.
Jespren, thanks for explaining the whole admitting privileges thing. I was a little unclear about it but also too lazy to bother looking it up.
The clinic was in violation! Did you read where I wrote there was filthy surgical equipment? Lets just sweep that under the rug… run it through your search engines and get back to me.
I ran it through a search engine, and the “filthy surgical equipment” constituted mold in a rubber tube attached to a bottle used to fill an autoclave. This is not good, obviously, but it was rectified during the inspection and the mold would not have come into contact with surgical instruments because the autoclave itself sterilizes the water that it uses. Some expired medications were also discovered–some were one week past their expiration dates, and some were six weeks past. The clinic said that the medications were to be discarded, and no one has said that patients were given expired medication. And no one has said that that was a factor in the clinic’s closure.
The inspection also found rust in the brackets attaching stirrups to exam chairs, and on the covers of the heating units. If you run it through a search engine, you’ll find that heating unit covers are not used to perform surgery.
As far as I know, no legitimate body of medical professionals thinks that it is necessary for abortion practitioners to have hospital admitting privileges. But the pro-life movement is not in the business of legitimate medical practice.
I notice that the pro-life media has chosen not to reveal that Medicare/Medicaid “fraud” disputes have been very common in the past decade, often because the government and the providers disagree on how to code medical procedures and on what procedures are necessary. The University of Washington medical centers, Beth Israel in Boston, and several different Catholic healthcare organizations have all paid out larger settlements in similar cases in recent years.
Of course, all of that pales in comparison to the nearly $2,000,000,000 in fines that Columbia/HCA paid for fraud committed under the leadership of Florida’s pro-life governor, Rick Scott. Oddly, LifeNews never mentions that.
Did you notice that you simply made certain claims and expected it to just be accepted as fact Heather?
Did you notice that you simply made certain claims and expected it to just be accepted as fact Heather?
And those claims probably were accepted as fact by many of not most readers. Heather knows her audience.