BREAKING: Third Medicaid fraud lawsuit emerges against Planned Parenthood Gulf Coast
A 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]
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.
PP is too politically important for its supporters to do anything about abuses. Hopefully the court that deals with this isn’t packed with them.
Regarding clinics shutting down soon after the appearance of Medicaid fraud: The El Paso clinic closed down when its accounting was about to be investigated.
http://archive.newspapertree.com/news/4082-planned-parenthood-of-el-paso-closure-status-more-than-a-half-million-in-debt-and-a-state-investigation
For more info, you can google “el paso planned parenthood accounting”
It may thus be a strategy to cut PP clinics loose, as was done in San Francisco, or close them, as in PPGC and El Paso, when The Man is catching up with ya.
I am an accountant, so I will try to explain some technical stuff:
People who commit fraud go to jail. This can be difficult crime to prove, because individuals can hid their tracks pretend that they did not know.
Institutions who overbill MedicAid must pay it back, even if the error was an honest mistake. If intentional fraud is suspected, there may be additional sanctions. This is much easier to prove, because billing dollars always leave a trail.
One way to prove a billing error is to examine actual bills, and note that certain types of billing were illegal. This requires a knowledgeable whistle-blower.
The more common way to find a billing fraud is to look at sudden increases and decreases in revenues. See how Ms. Carroll noticed the 315% spike in revenue.
This is why PP closed the clinics under suspicion. Suppose that PP is gouging MedicAid. Regulators get suspicious, and put PP on notice. PP cleans up their act and everything is squeaky clean. After several months, the regulators can come back with some awful news: “We have been examining your operations, and everything is squeaky clean. But your revenues dropped by 50% after we put you on notice. If you cannot explain this sudden loss, we will judge that you have been gouging us for that amount over the last 5 years, and we demand a refund.”
So the only way to hide the evidence is to close the clinic, which provides the perfect excuse for the complete loss of all revenues.
It was genius of PP to use the Texas law as an excuse, buying some positive sympathy as they covered up their crimes.
Thanks for the info, Del.
One of my friends who participates in the 40 days for Life always prays for the clinic workers. Interesting that these revelations are coming from the inside of PP.