Texas AGO obtains $1.4 mil settlement against PP for Medicaid fraud

[nota bene]

HOUSTON – The Texas Attorney General’s Office today concluded the State’s Medicaid fraud investigation into Planned Parenthood Gulf Coast, Inc. Under today’s agreement, Planned Parenthood Gulf Coast must pay $1.4 million for fraudulently overbilling the taxpayer-funded Medicaid program.

After a whistleblower lawsuit was filed alleging improper billing practices by Planned Parenthood Gulf Coast, an investigation was opened by the Texas Attorney General’s Office and the Texas Health and Human Services Commission’s Office of Inspector General. The State’s investigation revealed that Planned Parenthood Gulf Coast improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and were not covered by the Medicaid program – and were therefore not eligible for reimbursement. For example, state investigators determined that Planned Parenthood Gulf Coast falsified material information in patients’ medical records in order to support fraudulent reimbursement claims to the Medicaid program. https://www.oag.state.tx.us/oagNews/release.php?id=4455

Some of the money recovered will go to the feds. Happily, however, none will be spent to upgrade the three abortion facilities that closed today in Texas. Bryan Planned Parenthood closed for good | khou.com Houston

 

[SassySmartie]

But Planned Parenthood Gulf Coast said in a statement today that the allegations were baseless. The organization said it had chosen to settle for practical reasons.

According to the Planned Parenthood press release: “Continuing this litigation in the hostile environment for women’s health would have ensured a lengthy and costly process that would have distracted our energies and required us to share the private medical information of thousands of women.”

Here’s where the story gets bizarre. The allegations against Planned Parenthood had been made in a whistleblower lawsuit. According to the Texas Medicaid Fraud Prevention Act, the whistleblower is entitled to some of the settlement money.

But who might that whistleblower be? It’s Karen Reynolds, a former Planned Parenthood health care assistant who worked at the Lufkin clinic from from 1999 to 2009. Reynolds said that she witnessed clinic staff falsifying claims and billing documents as well as violating federal rules for Title X family planning funds, among other claims.

In a nearly identical suit, Abby Johnson, the ex-director of a Bryan clinic run by Planned Parenthood Gulf Coast, also filed a claim against the affiliate. But as a previous Observer report found, Johnson doesn’t have the best track record for accuracy. Johnson became an anti-abortion rights celebrity when she wrote a book about her experiences of converting to the “pro-life” cause. She now holds several positions at high profile anti-abortion rights organizations. The conservative Washington Times reported earlier last year that Johnson had filed her suit against Planned Parenthood and that she could receive as much as 30 percent of the final settlement in this lawsuit. In March, the federal judge in the Johnson case moved to dismiss Johnson’s lawsuit because it “alleges the same ‘essential facts’ and ‘material elements’ of fraud” as Reynolds’ suit.

As the whistleblower in this politically-charged case, Reynolds could be in for a tidy sum of money.
Planned Parenthood Affiliate to Pay $1.4 Million in Medicaid Fraud Settlement | The Texas Observer

It's a settlement, not a court judgment.

 

[year2late]

OMG!!!!

Catholic Healthcare West must pay 9.1 million !!!

This must mean that abortions ARE ok, because they are even worse!!!

Catholic Healthcare West Pays $9.1M to Settle False Claim Allegations

Seriously...WTF do these issues have to do with abortion debates.

 

[JayDubya]

Seriously...WTF do these issues have to do with abortion debates.

Here, let me help you out there.

HOUSTON – The Texas Attorney General’s Office today concluded the State’s Medicaid fraud investigation into Planned Parenthood Gulf Coast, Inc.

Planned Parenthood Gulf Coast, Inc.

PLANNED PARENTHOOD

 

[nota bene]

OMG!!!!

Catholic Healthcare West must pay 9.1 million !!!

This must mean that abortions ARE ok, because they are even worse!!!

Catholic Healthcare West Pays $9.1M to Settle False Claim Allegations

Seriously...WTF do these issues have to do with abortion debates.

I thought the OP made a connection clear, but okay.

Let's see--Medicaid fraud has now cost PP $1.4 million in Texas. Cost to upgrade the three clinics in the same state that have now closed because PP chose not to upgrade in compliance with the new law? Unknown. But I'll bet $1.4 million would help.

 

[year2late]

Here, let me help you out there.

You do not get it, billing issues are not only associated to Planned Parenthood. My point (of course) was to show it was widespread and it is even a huge issue with many facilities - even non abortion non contraceptive giving facilities. How in the hell does this make an abortion debate.

Do you realize how many NON PP facilities are scrutinized, and made to pay - either through settlement or legally?

Please tell me how this makes its way into an abortion debate.

 

[joko104]

Here, let me help you out there.

I'll help you out too in your manner:

Catholic Healthcare West

The anti-abortion organization is 800% more evil by your measure.

 

[nota bene]

The font size won't help. The Catholic Healthcare West overbilling occurred in the '90's and in California, Arizona, and Nevada. This thread is about another set of circumstances--the falsifying of patient records--in Texas. And I began this thread because Texas has recently changed its law, with PP responding by closing clinics.

 

[SassySmartie]

The font size won't help. The Catholic Healthcare West overbilling occurred in the '90's and in California, Arizona, and Nevada. This thread is about another set of circumstances--the falsifying of patient records--in Texas. And I began this thread because Texas has recently changed its law, with PP responding by closing clinics.

Texas has a lot of Medicaid fraud:

February 7, 2013 -- The Texas Attorney General's Office has racked up more than $1 billion in Medicaid fraud recoveries over the last 10 years. Of that, the state has recovered more than $400 million since 2002 resulting from its Medicaid fraud investigations.

While these efforts are impressive, Texas has so far recovered only $1.8 million from its investigations of dental Medicaid fraud -- and this in a state that spent $705 million on Medicaid orthodontics between 2008 and 2011, and whose Medicaid orthodontics reimbursements in 2009 alone totaled nearly 75% of the rest of the U.S. combined.

In fact, Medicaid spending habits in Texas have prompted numerous investigations of fraud and a flurry of activity at the state and federal levels designed to improve the Medicaid system. Last October, the Texas Attorney General's Office and the Office of Inspector General at the Health and Human Services Commission (HHSC) formed a task force designed to target Medicaid dental fraud. The task force is working to improve investigations of fraudulent charges to the children's Medicaid program and recover losses more quickly.

And it seems Gregg Abbott lets his personal politics guide his decisions regarding these fraud suits.

It seems to me that part of the problem is in the way that Medicaid handles their claims and whether or not they verify charges before paying claims. Furthermore, settlements are not an admission of guilt in any way. They typically mean that the defendant would rather settle and pay fees instead of spending the time, money and resources on a protracted legal battle. It's very typical for lawsuits to be settled for a cash amount and never go to court. This happens in both the civil court system and criminal court system.

As far as new laws are concerned PP hasn't that I'm aware of, pretended that these 3 clinics closed because of new laws. Texas has cut funding from PP a couple of years ago and the clinics have slowly been going under.

 

[nota bene]

From HuffPo [bolding mine]:

Planned Parenthood on Wednesday informed staff at three of its facilities in Texas that they would be closing, according to people familiar with the decision.

The three clinics are located in Bryan, Huntsville and Lufkin, Texas. They are closing in response to a new package of abortion restrictions signed into law on Thursday and funding cuts to Texas' Women's Health Program that were passed by the Texas state legislature in 2011.

Planned Parenthood To Close Three Texas Clinics

The fallout begins: 3 clinics closing because of Texas’ antiabortion crusade - Salon.com

 

[specklebang]

If all states and the federales would focus on fraud, we'd have plenty of money to help those truly in need instead of a bunch of thieves living the good life on their stolen money.

Just the fact that this one case is getting so much press shows how rare it is for them to catch up with the crooks. I bet 99% of them get away with it and yet this is never prioritized or mentioned by any President or candidate.

 

[SassySmartie]

Furthermore, Gregg Abbott has a track record of poorly managing oversights and doing favors for his friends for example his performance in CPRIT [Cancer Prevention and Research Institute of Texas]:

Abbott never has attended any of CPRIT’s 23 meetings. Even as the agency was barreling toward near-death, he sent an aide to fill the chair.

A succession of problems has beset CPRIT: conflicts of interest, allegations of favoritism, widespread resignations, and an $11 million grant made to a Dallas company without the required scientific or business review.

But the attorney general, the state’s chief legal officer, demonstrated little apparent interest, based on his correspondence. Over the past five years, Abbott exchanged only nine emails with key state officials concerning CPRIT, an examination of records by The Dallas Morning News found.

Abbott said his behavior arose from his anticipation of possible future conflicts. Picking a high-ranking assistant to take his place “allowed me to retain the independence to take action to respond to any broader challenges posed by CPRIT,” Abbott said in a written statement. “Hindsight proved foresight correct.”

Despite his proclamations of independence, the attorney general — a possible candidate for governor — now has entered a political and bureaucratic maze at CPRIT.

Last December, Abbott’s office announced that it would investigate CPRIT. Abbott is therefore in the position of investigating an agency over which his office already had oversight. As part of this inquiry, the attorney general potentially is looking into the behavior of board members from whom he has accepted campaign contributions.

To complicate matters further, Abbott is investigating the agency’s granting of money to a company that had an Abbott campaign donor as an investor. A law firm representing that company also has served as legal counsel for Abbott’s campaign organization. That same law firm has contributed $160,000 to Abbott’s campaigns since 2001.

In addition, Abbott’s office is representing CPRIT, as legal counsel, in its dispute with a foundation created to raise private funds for the public agency. Among the foundation’s donors are people who also have given money to Abbott’s campaigns.

I'm a Texan and I'm very skeptical at this point of any information coming out of Abbott's office. He doesn't seem to care about anything but campaign contributions, and his decisions are highly politically motivated, instead of the best interests of the State.

 

[nota bene]

I'm all for rooting out Medicaid and Medicare fraud wherever it is. And I'd infinitely prefer doing this and otherwise improving these than the looming nightmare that is "Obamacare."

 

[SassySmartie]

From HuffPo [bolding mine]:

Planned Parenthood on Wednesday informed staff at three of its facilities in Texas that they would be closing, according to people familiar with the decision.

The three clinics are located in Bryan, Huntsville and Lufkin, Texas. They are closing in response to a new package of abortion restrictions signed into law on Thursday and funding cuts to Texas' Women's Health Program that were passed by the Texas state legislature in 2011.

Planned Parenthood To Close Three Texas Clinics

The fallout begins: 3 clinics closing because of Texas’ antiabortion crusade - Salon.com

Actually the planned parenthood official statement does not claim that the closings are in response of the newest anti-abortion bills, it says due to constant costs associated with recent legislation, Texas has passed many new laws defunding Planned Parenthood over the last two or three years.

Planned Parenthood has been excluded from Texas Medicaid funding since 2011 when Perry signed into law a bill that disallows funding to any healthcare provider 'affiliated' with an abortion provider. Something in the ballpark of 60 clinics closed after this bill. Planned Parenthood has been in a legal battle since then with Texas. The move caused Texas to lose Federal dollars for women's healthcare as well, so the PP clinics have been operating with a very meager budget.

 

[SassySmartie]

I'm all for rooting out Medicaid and Medicare fraud wherever it is. And I'd infinitely prefer doing this and otherwise improving these than the looming nightmare that is "Obamacare."

Then I suggest you don't vote for Gregg Abbott for the next Texas governor.

 

[YoungConserv]

If all states and the federales would focus on fraud, we'd have plenty of money to help those truly in need instead of a bunch of thieves living the good life on their stolen money.

Just the fact that this one case is getting so much press shows how rare it is for them to catch up with the crooks. I bet 99% of them get away with it and yet this is never prioritized or mentioned by any President or candidate.

So you ever think that the scope of these programs might make controlling the fraud nearly impossible?

 

[minnie616]

I think with proper oversights they can stop most the fraud but not all of it.

I am glad they caught with the scooter store fraud.
People who truly need powered wheelchairs should get them but for those who have limited mobility and can get around a little bit they should use walkers , regular wheel chairs or mobility scooters ( according to their needs ) which are much less expensive.

 

[specklebang]

Unfortunately, I believe that enforcement is deliberately lax because some vested powers benefit from fraud, financially and politically. This is not penny-ante. Billions are involved and when you get to numbers like that you become very interested. Just like the IRS, a Fraud agency theoretically would more than pay for itself. But who will watch the watchman?

So you ever think that the scope of these programs might make controlling the fraud nearly impossible?

 

[YoungConserv]

Unfortunately, I believe that enforcement is deliberately lax because some vested powers benefit from fraud, financially and politically. This is not penny-ante. Billions are involved and when you get to numbers like that you become very interested. Just like the IRS, a Fraud agency theoretically would more than pay for itself. But who will watch the watchman?

So isn't a easier way to prevent fraud to vastly reduce the scope of these programs and only limit them to the very basics.

 

[nota bene]

HOUSTON – The Texas Attorney General’s Office today concluded the State’s Medicaid fraud investigation into Planned Parenthood Gulf Coast, Inc. Under today’s agreement, Planned Parenthood Gulf Coast must pay $1.4 million for fraudulently overbilling the taxpayer-funded Medicaid program.

After a whistleblower lawsuit was filed alleging improper billing practices by Planned Parenthood Gulf Coast, an investigation was opened by the Texas Attorney General’s Office and the Texas Health and Human Services Commission’s Office of Inspector General. The State’s investigation revealed that Planned Parenthood Gulf Coast improperly billed the Texas Medicaid program for products and services that were never actually rendered, not medically necessary, and were not covered by the Medicaid program – and were therefore not eligible for reimbursement. For example, state investigators determined that Planned Parenthood Gulf Coast falsified material information in patients’ medical records in order to support fraudulent reimbursement claims to the Medicaid program. https://www.oag.state.tx.us/oagNews/release.php?id=4455

Some of the money recovered will go to the feds. Happily, however, none will be spent to upgrade the three abortion facilities that closed today in Texas. Bryan Planned Parenthood closed for good | khou.com Houston

UPDATE:

Planned Parenthood Gulf Coast Tuesday settled a whistle-blower lawsuit that alleged the Houston nonprofit engaged in fraudulent Medicaid billing for $4.3 million – nearly $3 million more than was announced last week by Texas Attorney General Greg Abbott.

In finalizing the settlement, which includes total state and federal recovery, the agency claimed the allegations that it submitted more than $30 million in fraudulent bills between 2003 and 2009 were "baseless." Planned Parenthood finalizes $4.3 million lawsuit settlement - Houston Chronicle

 

[Kal'Stang]

OMG!!!!

Catholic Healthcare West must pay 9.1 million !!!

This must mean that abortions ARE ok, because they are even worse!!!

Catholic Healthcare West Pays $9.1M to Settle False Claim Allegations

Seriously...WTF do these issues have to do with abortion debates.

Absolutely nothing. The only reason that this thread was put in here was because 3% of PP's services is abortion and some people want to do everything that they can to equate one thing that they consider bad to another thing that they know is bad. It is of course nothing more than intellectual dishonesty.

 

[nota bene]

Absolutely nothing. The only reason that this thread was put in here was because 3% of PP's services is abortion and some people want to do everything that they can to equate one thing that they consider bad to another thing that they know is bad. It is of course nothing more than intellectual dishonesty.

Speaking of intellectual dishonesty, now that you've offered your ugly little ad hom, do you suppose that if I boil down my OP to just one word--"irony"--you'll get it?

 

[specklebang]

Can you amplify that a bit more?. What changes are you suggesting and how will these changes assure honesty? The "scope" or MedicAid is to fund health services that are means tested. Surely you're not proposing "Death Panels"?

Most of the fraud is claims for services not actually rendered. Crooks will be crooks. So, I'll be interested to hear your proposal.

So isn't a easier way to prevent fraud to vastly reduce the scope of these programs and only limit them to the very basics.

 

[Kal'Stang]

Speaking of intellectual dishonesty, now that you've offered your ugly little ad hom, do you suppose that if I boil down my OP to just one word--"irony"--you'll get it?

Since when is the truth considered "ugly little ad hom"? You made this thread, tell me, why put a subject about fraud in the abortion sub-forum?

 

[nota bene]

Can you amplify that a bit more?. What changes are you suggesting and how will these changes assure honesty? The "scope" or MedicAid is to fund health services that are means tested. Surely you're not proposing "Death Panels"?

Most of the fraud is claims for services not actually rendered. Crooks will be crooks. So, I'll be interested to hear your proposal.

Could you please use the ordinary format and position the quote first?