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Saturday, 10 August 2013 20:15

Planned Parenthood Pays Hefty Settlement in Texas Medicaid Fraud Case

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The final settlement in a Planned Parenthood whistleblower Medicaid fraud lawsuit in Texas turned out to be significantly higher than the $1.4 million announced July 30 by Texas Attorney General Greg Abbott. The Houston Chronicle reported that Planned Parenthood Gulf Coast will pay a total of $4.3 million to the federal government, the state of Texas, and Karen Reynolds, the former Planned Parenthood employee who blew the whistle on the abortion business.

In the specifics of the case, the Southeast Texas Record, a state legal journal, reported that “Planned Parenthood Gulf Coast allegedly improperly billed the Texas Medicaid program for services and products that were not rendered, not medically necessary, and were not covered by the Medicaid program. The alleged improper billing practices were not eligible for Medicaid reimbursement. Planned Parenthood Gulf Coast allegedly falsified material information in the medical records of patients to support fraudulent Medicaid reimbursement claims.”

Reynolds brought the alleged fraud, which she contended stretched back over the 10 years of her employment, to the attention of the Texas attorney general's office, which launched an investigation. LifeNews.com reported that the investigation uncovered compelling evidence that Planned Parenthood Gulf Coast had submitted false claims and made false statements in connection with claims submitted to Medicaid and the Texas Women’s Health Program.

According to the lawsuit, Planned Parenthood's “billing policies routinely instructed clinic staff to enter billing codes for certain services, regardless of whether patients' charts recorded that such service was actually provided.”

In response to the settlement, Planned Parenthood Gulf Coast issued a statement insisting that the “allegations that it submitted more than $30 million in fraudulent bills between 2003 and 2009 were 'baseless,'” reported the Houston Chronicle. In its prepared statement Planned Parenthood emphasized that its payment of the settlement “is not an admission of guilt.”

Under the terms of the settlement, wrote pro-life activist Jill Stanek on LifeNews.com, the federal government will receive the bulk of the money, $2,552,169, with $500,831 going to the state of Texas, and whistleblower Reynolds receiving a hefty bounty of $1,247,000.

Responding to the news, Sarah Crawford of Texas Right to Life wrote that the settlement demonstrates “the desperation of the abortion industry to keep its tendrils in the pockets of taxpayers. Under federal rules, any provider convicted of fraud is ineligible for federal healthcare dollars for a minimum of five years. Seemingly, the threat of losing the only government funding stream left for them in Texas motivated them to settle their fraud lawsuit even at such a high cost.”

Crawford added that the the abortion giant “lies to women as well as to every state in the nation about its true motives. Though Planned Parenthood claims their abortion services are entirely separate from actual medical services, even the Houston Chronicle featured an article stating otherwise. Planned Parenthood is concerned with keeping the lucrative abortion business thriving while scamming women and the American people.”

3 comments

  • Comment Link OldmanRick Saturday, 17 August 2013 12:52 posted by OldmanRick

    Fascinating. An alleged 30 million dollars was billed over 10 years, but PP only has to pay back 4.3 million. I call that a win win for PP and a Loss of 25.7 million for taxpayers.

  • Comment Link Heidi Preston Monday, 12 August 2013 18:20 posted by Heidi Preston

    The best move Texas ever did, was to cut funding to Planned Parenthood.
    1.Tax payers were paying for Abortions of women even though they had nothing to do with the act (except the two involved) but were accountable for the deed.
    2.Tax payers were paying for the legal fees and court costs Planned Parenthood used to go to court to fight amendments to legal processes.
    3.Tax payers were paying for the excess payments to fraudulent claims (for what ever reason used to justify it).

    So tell me again where this "it's my body, my choice " comes in? Your body, your choice, your payment...not mine or any other tax payer.

  • Comment Link rprew Saturday, 10 August 2013 21:49 posted by rprew

    ... “billing policies routinely instructed clinic staff to enter billing codes for certain services, regardless of whether patients' charts recorded that such service was actually provided.”

    There are two reasons for over billing. One is greed. The second is the necessity to survive low insurance payments and escalating costs.

    Escalating costs arise because of the need to process insurance billing, collecting, and paperwork.

    Low payouts are needed because on a general level, payouts plus operational expenses must not exceed income (insurance premiums). Premiums (income) keep rising, but so do costs (payouts plus expenses).

    In totality, the cost of insurance (to the consumer) exceeds the benefits received. This is true for all forms of insurance. The original purpose of insurance was to spread risk.

    The best healthcare reform we could possibly make would be to return to the original use of insurance. This would mean that health providers would bill ONLY patients and get payment ONLY from patients. The patients, IF they opted to share risk (buy insurance) would submit paid bills to their insurance companies for reimbursement.

    When healthcare providers no longer need to deal with insurance companies, their costs will be lowered. Depending on payment from patients, they would strive to be both competitive and competent.

    Patients, needing to keep their costs down, will search for providers who are the most competent and the best priced. They will also be wary of billing for procedures never performed. This makes the providers more honest. When purchasing insurance, people will weigh several factors. These will include cost and the potential benefit considering risk.

    Insurance sales depend on the same factors of cost (income), benefit (payout), and risk (likelihood of making a payout).

    The end result would be most people having NO insurance for routine or preventative care. The cost (premiums and deductibles) of insurance would exceed the benefit (payouts) of having it. On the other hand, people WOULD buy insurance for catastrophic events, such as cancer or heart disease. In other words, they would want to spread risk.

    Considering risk, nearly everyone has (or will have) need for routine and preventative care. It is silly to have insurance for this type of risk. Benefit can never exceed (or even come close to meeting) costs. (Consider premiums, deductibles and co-pays.) Events such as cancer or heart disease is different. Spreading risk is a viable approach. Individually, each person will hope for all cost and no benefit, but if benefit is ever needed...

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