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Shock Claim: Whistle-Blower Says Planned Parenthood Clinics Defrauded Gov't to Pay for Abortion-Related Services


"billing the government for unwarranted services"

Planned Parenthood continues to find itself in the midst of controversy. Karen Reynolds, a former employee at one of the organization's Lufkin, Texas, clinics, has blown the whistle on an alleged multi-million-dollar billing scheme.

Reynolds, who worked as a health center assistant for the clinic from 1999 until 2009, claims that she was instructed to help the organization bring in optimal revenue by falsifying records. In the end, this purportedly enabled the organization to extract monies from Medicaid and the Women's Health Program for services that were never granted.

According to Reynolds, this was the procedure that staff followed in all 12 Planned Parenthood Gulf Coast clinics in both Texas and Louisiana. The Lufkin News reports:

The suit alleges that, in addition to falsifying patient records, billing the government for unwarranted services and services not covered by Medicaid, Planned Parenthood tacked on services patient did not receive.

An example given in the suit is Medicaid being billed for birth control counseling. The suit states almost all Women’s Health Program and Medicaid patients were handed a bag of at least two birth control devices despite the fact the items were not needed or requested by the patient.

After giving these bags out, the lawsuit alleges that the condoms and vaginal film present within the packages were billed to the government for a cost of $57.85. This action was apparently purposeful, as Reynolds claims that employees were taken through "PowerPoint" sessions on how they could most efficiently defraud taxpayers.

Pro-life writer Jill Stanek quotes some sections of the complaint (read the entire document here):

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.

Another, more startling portion alleges that the organization billed the government for abortion services:

One notable example of this practice relates to PPGC policies for obtaining payment for abortion-related services. WHP, Medicaid, and some other government programs do not allow payment for abortion-related services including “follow-up visits” after an elective abortion procedure. The following is a direct quote from a staff meeting memorandum given to clinic employees

January 22, 2009:

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

At the moment, the startling case is still in its early stages, as the trial isn't set to unfold until April 2013. If Planned Parenthood Gulf Coast loses the case, it will need to pay the federal government and the state of Texas a lump sum for the alleged actions.

You can read more about this case here.

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