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

[mac]

False claims are fraud.

Not if it was an error.

Who said anything about an excuse?

You, by posting this instead of answering.

I was agreeing it is sneaky for any organization, including Catholic Healthcare to take funding then file false claims.

It's sneaky if it was intentional, incompetence if it was not.

 

[sangha]

According to that article, they did. Please learn to read.

The OP doesn't link to an article. Please learn to tell the truth

 

[mac]

You seem to think that there are no alternative to PP clinics. There are. I'll happily pay my fair share to support more and continue supporting the ones already in existence. Women's health care is very important to me, especially prenatal care.

And I look forward to the day when PP no longer exists.

Says a lot about you that you're calling me a liar when I say that I've never heard anybody complain about PP's other services. I never have.

Sangha is the most dishonest poster on DP, rest assured, if he's calling you liar, it's because he's beat and blowing smoke. AKA lying.

 

[mac]

The OP doesn't link to an article. Please learn to tell the truth

Ok, report. You should read it, because you sound more foolish than normal.

Under the agreement announced today, Planned Parenthood Gulf Coast must pay $1.4 million to resolve the Medicaid fraud enforcement action.

 

[sangha]

Ok, report. You should read it,

No, not a report; a political statement

Try again

 

[mac]

No, not a report; a political statement

Try again

That's the Texas AG website, homey. It's not a political statement, it's a report of their actions and the result. Your desperation reeks.

 

[sangha]

That's the Texas AG website, homey. It's not a political statement, it's a report of their actions and the result. Your desperation reeks.

It's a political statement issued by someone who holds a political position.

 

[mac]

It's a political statement issued by someone who holds a political position.

The stink of denial and desperation gets heavier in the air with your every post.

 

[sangha]

The stink of denial and desperation gets heavier in the air with your every post.

True. Your posts do get more desperate every time you respond

The fact remains that there was no Medicare fraud

 

[minnie616]

PP didn't engage in fraud

Please stop lying

You are correct.

I stand corrected.
There was allegations that false claims were filed by PP and by Catholic health care West.

And they both have settled and did or will pay their settlements.

 

[SassySmartie]

We could get the government completely out of it.

Get the government completely out of what, exactly? What's your great solution?

 

[SassySmartie]

Did she lie? Evidence to support this character assassination? And as a whistleblower, while you're at it, did she lie then too? And was the Texas AG fooled? And was the $4.3 million-dollar judgment thus false?

The Bryan clinic reported performing fifteen surgical abortions on September 26. Johnson has consistently said that the patient in question was thirteen weeks pregnant, which is plausible, since thirteen weeks is right at the cusp of when physicians will consider using an ultrasound to assist with the procedure. Yet none of the patients listed on the report for that day were thirteen weeks pregnant; in fact, none were beyond ten weeks.

The Convert: Former Bryan Planned Parenthood director Abby Johnson’s abrupt change from pro-choice activist to pro-life spokesperson turned her into a talk show sensation. But is her story true?

Also, it's been posted several times that it is a SETTLEMENT not a judgement. IOW, it wasn't proved that PP was doing anything wrong. PP simply settled to avoid legal costs. Here, are a few facts [emphasis mine]:

The headline of Abbott's press release clucked "Texas Attorney General's Office Obtains" settlement.

It claimed that, although the fraud allegations were first brought by a whistle-blower lawsuit, the AG's office had conducted, and concluded, its own investigation of the local organization, which "revealed" that the group had 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."

[. . .]

Both Abbott's office and the federal government declined to get involved in the whistleblower case when they were approached early on.

While this is a common strategy by government agencies with limited resources, the decision at one point prompted presiding U.S. District Judge Ron Clark to tell attorneys in the case, "I'm very mindful of the fact that the government 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."

[. . .]

Documentation lacking

When I asked for memorandums, emails or any kind of documents that would show the Planned Parenthood affiliate intended to defraud the Medicaid program, Abbott's spokesman Jerry Strickland told me the whistle-blower's attorney "would have that information" and "we do not have those documents with us right now."

The lawsuit was brought by Karen Rey*nolds, a former medical assistant who was fired from a Planned Parenthood clinic in Lufkin and will share in the settlement.

Reynolds' attorney, Michael Love, of Lufkin, said Monday he wouldn't comment on pending litigation.

Abbott's spokesman also couldn't say why, if the attorney general was so concerned about "fraudulent" bilking of the taxpayers, he didn't pursue criminal action as he has against other Medicaid cheaters.

I'm not saying there's not real fraud here.

The affiliate maintains that the lawsuit's allegations were baseless and its settlement was a practical decision to save millions of private dollars that would otherwise go to providing care: "This settlement is about the cost of continuing to defend against these claims in an increasingly hostile environment for women's health," spokeswoman Rochelle Tafolla said Tuesday in a statement.

 

[Dr. Chuckles]

you're kinda mincing words here and I doubt you grant such latitude to the various other entities that settle out of court daily. Also, such abuse in our health care system is hardly unique. Not sure of the root cause of it, but the fact that it seems so common makes me assume that the failure it is on the part of the govt

 

[nota bene]

The Convert: Former Bryan Planned Parenthood director Abby Johnson’s abrupt change from pro-choice activist to pro-life spokesperson turned her into a talk show sensation. But is her story true?

Also, it's been posted several times that it is a SETTLEMENT not a judgement. IOW, it wasn't proved that PP was doing anything wrong. PP simply settled to avoid legal costs. Here, are a few facts [emphasis mine]:

Abby Johnson's whistleblower suit isn't part of this $4.3 million-dollar settlement. That suit is still pending, and according to Jill Stanek:

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 a Planned Parenthood affiliate of fraud."

She lists several points of the settlement: BREAKING: Bombshells in Parenthood Gulf Coast's $4.3m fraud settlement

Here is the link to the settlement document itself: Planned Parenthood Gulf Coast $4.3 Million Settlement Agreement with Government

 

[mac]

True. Your posts do get more desperate every time you respond

The fact remains that there was no Medicare fraud

Of course there was.

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

 

[SassySmartie]

Abby Johnson's whistleblower suit isn't part of this $4.3 million-dollar settlement. That suit is still pending, and according to Jill Stanek:

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 a Planned Parenthood affiliate of fraud."

She lists several points of the settlement: BREAKING: Bombshells in Parenthood Gulf Coast's $4.3m fraud settlement

Here is the link to the settlement document itself: Planned Parenthood Gulf Coast $4.3 Million Settlement Agreement with Government

You asked for proof of Abby Johnson's lying.

Secondly, the neither the US Dept of Justice nor the State of Texas bothered to investigate any of Karen Reynold's complaints. Furthermore, as a whistleblower, in Texas, Reynolds gets a share of any settlement or fees collected. Her complaints were originally filed in 2009, neither Texas nor the US DOJ pursued charges. Karen Reynolds then sued PP on behalf of the DOJ and the State of Texas. A large portion of her complaints were dismissed outright because of the lack of action taken by both gov't agencies and because she did not provide specific evidence of frauds. IOW, she alleged a billing scheme but did not provide specific cases or patient charts where the alleged fraud took place. Furthermore, the judge limited her complaint to post 2007 as too much time had elapsed.

PP has been dealing with this since 2009. Taking a case like this to trial is extremely expensive. How much do you think it costs to copy every single patient record from 2007-2009? During the discovery phase of a trial, PP would be required to produce all patient charts in that time period, box and ship them to the plaintiff, with copies to the court, they also have to pay their legal team to sort through, organize and investigate their defense and answer various other pleadings and motions moving towards the trial. It is quite common in civil actions like this for the Defendant to settle because the costs of going to trial are burdensome and time consuming. Further, for PP in particular, which will be participating in numerous legal actions as a result of new legislation to sue states to reverse these ridiculous laws, they had to weigh whether they want to tie up time and funding in fighting this case, or cut their losses to focus on upcoming legal battles.

AGAIN, there was not a JUDGEMENT of guilt. You keep writing as if you think that the US Dist Court Eastern District Lufkin Division has RULED on this case. They have NOT. The parties [i.e. Reynolds and PP] instead chose to agree on a dollar amount to settle and drop the case. Which if Reynolds had real, substantial evidence, why would she settle? She'd stand to get a cut of the alleged $30 million in alleged fraud money. Instead she settled for a cut of the $1.4 million that will be paid to Texas. Wonder why that is? A settlement Agreement must be agreed on by all parties involved and the monetary amount must be agreed on by all parties. A defendant cannot offer to settle to the judge and unilaterally drop the case. The parties make a settlement arrangement in lieu of going to trial, the defendant admits no wrongdoing, and parties agree to the amount of money to be paid and how it will be dispersed.

ORDER GRANTING IN PART DEFENDANT’S MOTION TO DISMISS

After the dismissal linked above, Reynolds filed this:

THIRD AMENDED COMPLAINT
AND DEMAND FOR JURY TRIAL

Where on page 17 you can see the alleged fraudulent charges. Though, ya know, I find it hard to see how a complete STD screen isn't 'necessary' or appropriate when a patient comes in suspecting she has a particular STD, since, if she's at-risk and having symptoms of one STD, she'd be at-risk for others. I also find it completely plausible that Self-Pay clients would opt not to have extra services, since 'self-pay' means they're paying completely out of pocket for services and probably can't afford a full panel of tests. It seems to me that these 'unnecessary' procedures are part of women's health and in the ideal scenario and best case scenario, women would have affordable, equal access to all of these procedures. Would you really argue that if a woman comes into a health clinic for a pregnancy test, that she does not also need contraceptive counseling and contraceptives? Since the fact that she may be pregnant means her contraception may not be the right contraception and/or might not be the most effective, or maybe she needs more education on the appropriate use of that method?

In both the Johnson and Reynolds cases, we see a disgruntled employee [in Johnson's case FIRED and LIED about what she saw] [in Reynold's case had been written up as disciplinary action at work, and in a position to lose her job] that worked for many years, according to their own testimonies, participated in alleged falsifications, yet waited until they were fired or in trouble to suddenly decide to report these alleged abuses. They also both stand to gain financially from such action. In Johnson's case, she became famous and a renowned speaker on the pro-life circuit. Both reek of retaliation and dishonesty. Neither can state specific cases of fraud.

 

[mac]

You asked for proof of Abby Johnson's lying.

Secondly, the neither the US Dept of Justice nor the State of Texas bothered to investigate any of Karen Reynold's complaints. Furthermore, as a whistleblower, in Texas, Reynolds gets a share of any settlement or fees collected. Her complaints were originally filed in 2009, neither Texas nor the US DOJ pursued charges. Karen Reynolds then sued PP on behalf of the DOJ and the State of Texas. A large portion of her complaints were dismissed outright because of the lack of action taken by both gov't agencies and because she did not provide specific evidence of frauds. IOW, she alleged a billing scheme but did not provide specific cases or patient charts where the alleged fraud took place. Furthermore, the judge limited her complaint to post 2007 as too much time had elapsed.

PP has been dealing with this since 2009. Taking a case like this to trial is extremely expensive. How much do you think it costs to copy every single patient record from 2007-2009? During the discovery phase of a trial, PP would be required to produce all patient charts in that time period, box and ship them to the plaintiff, with copies to the court, they also have to pay their legal team to sort through, organize and investigate their defense and answer various other pleadings and motions moving towards the trial. It is quite common in civil actions like this for the Defendant to settle because the costs of going to trial are burdensome and time consuming. Further, for PP in particular, which will be participating in numerous legal actions as a result of new legislation to sue states to reverse these ridiculous laws, they had to weigh whether they want to tie up time and funding in fighting this case, or cut their losses to focus on upcoming legal battles.

AGAIN, there was not a JUDGEMENT of guilt. You keep writing as if you think that the US Dist Court Eastern District Lufkin Division has RULED on this case. They have NOT. The parties [i.e. Reynolds and PP] instead chose to agree on a dollar amount to settle and drop the case. Which if Reynolds had real, substantial evidence, why would she settle? She'd stand to get a cut of the alleged $30 million in alleged fraud money. Instead she settled for a cut of the $1.4 million that will be paid to Texas. Wonder why that is? A settlement Agreement must be agreed on by all parties involved and the monetary amount must be agreed on by all parties. A defendant cannot offer to settle to the judge and unilaterally drop the case. The parties make a settlement arrangement in lieu of going to trial, the defendant admits no wrongdoing, and parties agree to the amount of money to be paid and how it will be dispersed.

ORDER GRANTING IN PART DEFENDANT’S MOTION TO DISMISS

After the dismissal linked above, Reynolds filed this:

THIRD AMENDED COMPLAINT
AND DEMAND FOR JURY TRIAL

Where on page 17 you can see the alleged fraudulent charges. Though, ya know, I find it hard to see how a complete STD screen isn't 'necessary' or appropriate when a patient comes in suspecting she has a particular STD, since, if she's at-risk and having symptoms of one STD, she'd be at-risk for others. I also find it completely plausible that Self-Pay clients would opt not to have extra services, since 'self-pay' means they're paying completely out of pocket for services and probably can't afford a full panel of tests. It seems to me that these 'unnecessary' procedures are part of women's health and in the ideal scenario and best case scenario, women would have affordable, equal access to all of these procedures. Would you really argue that if a woman comes into a health clinic for a pregnancy test, that she does not also need contraceptive counseling and contraceptives? Since the fact that she may be pregnant means her contraception may not be the right contraception and/or might not be the most effective, or maybe she needs more education on the appropriate use of that method?

In both the Johnson and Reynolds cases, we see a disgruntled employee [in Johnson's case FIRED and LIED about what she saw] [in Reynold's case had been written up as disciplinary action at work, and in a position to lose her job] that worked for many years, according to their own testimonies, participated in alleged falsifications, yet waited until they were fired or in trouble to suddenly decide to report these alleged abuses. They also both stand to gain financially from such action. In Johnson's case, she became famous and a renowned speaker on the pro-life circuit. Both reek of retaliation and dishonesty. Neither can state specific cases of fraud.

It's been going on since 2009 and they just now decided to settle because it would cost to much to go to trial?

Oh, come on.

 

[SassySmartie]

you're kinda mincing words here and I doubt you grant such latitude to the various other entities that settle out of court daily. Also, such abuse in our health care system is hardly unique. Not sure of the root cause of it, but the fact that it seems so common makes me assume that the failure it is on the part of the govt

What latitude? Also mincing how? there is a legal difference between a judgment and a settlement. I used to be a paralegal at a civil litigation firm. I understand how settlements work. Sometimes, companies settle because they know, for a fact they will be found in the wrong, so they settle for an amount they can afford to pay to keep from having a judgement against them. All settlements have a clause that the defendant is not admitting wrongdoing. Sometimes, companies settle because they cannot afford the costs of going to trial. From examining the pleadings I found online, it seems like PP was just avoiding the costs of litigation in this case, since Reynolds had no specific proof.

I don't disagree about abuse in the healthcare system. That deals with oversight by the state and insurance companies. Private insurance providers have a department that works around the clock to combat fraud. I'm not sure how state and federal systems oversee where the money from Medicaid or Medicare goes. Dentists are infamous for charging Medicaid for all kinds of unnecessary services.

From the list in the complaints about this particular PP clinic, I really don't see clear cut cases of unnecessary procedures. Since Reynolds is making blanket allegations, it's hard to say.

 

[SassySmartie]

It's been going on since 2009 and they just now decided to settle because it would cost to much to go to trial?

Oh, come on.

They got part of the complaint dismissed in August of 2012. I imagine the next few months were spent negotiating a settlement. These things don't move quickly. After only having part of the complaint dismissed, they would have to defend against the rest, they opted to pay out a settlement rather that deal with the expenses. Since, as I said, they'll be involved in many of the states litigations against the new wave of new laws recently passed. I'm sure they had to make some decisions about how to spend the finite amount of money they have.

 

[minnie616]

It's been going on since 2009 and they just now decided to settle because it would cost to much to go to trial?

Oh, come on.

The false charges allegations in the Catholic Healthcare link that yeat2late posted and I reposted took place in 1990s and they finally settled in 2011.

 

[nota bene]

You asked for proof of Abby Johnson's lying.

Secondly, the neither the US Dept of Justice nor the State of Texas bothered to investigate any of Karen Reynold's complaints. Furthermore, as a whistleblower, in Texas, Reynolds gets a share of any settlement or fees collected. Her complaints were originally filed in 2009, neither Texas nor the US DOJ pursued charges. Karen Reynolds then sued PP on behalf of the DOJ and the State of Texas. A large portion of her complaints were dismissed outright because of the lack of action taken by both gov't agencies and because she did not provide specific evidence of frauds. IOW, she alleged a billing scheme but did not provide specific cases or patient charts where the alleged fraud took place. Furthermore, the judge limited her complaint to post 2007 as too much time had elapsed.

PP has been dealing with this since 2009. Taking a case like this to trial is extremely expensive. How much do you think it costs to copy every single patient record from 2007-2009? During the discovery phase of a trial, PP would be required to produce all patient charts in that time period, box and ship them to the plaintiff, with copies to the court, they also have to pay their legal team to sort through, organize and investigate their defense and answer various other pleadings and motions moving towards the trial. It is quite common in civil actions like this for the Defendant to settle because the costs of going to trial are burdensome and time consuming. Further, for PP in particular, which will be participating in numerous legal actions as a result of new legislation to sue states to reverse these ridiculous laws, they had to weigh whether they want to tie up time and funding in fighting this case, or cut their losses to focus on upcoming legal battles.

AGAIN, there was not a JUDGEMENT of guilt. You keep writing as if you think that the US Dist Court Eastern District Lufkin Division has RULED on this case. They have NOT. The parties [i.e. Reynolds and PP] instead chose to agree on a dollar amount to settle and drop the case. Which if Reynolds had real, substantial evidence, why would she settle? She'd stand to get a cut of the alleged $30 million in alleged fraud money. Instead she settled for a cut of the $1.4 million that will be paid to Texas. Wonder why that is? A settlement Agreement must be agreed on by all parties involved and the monetary amount must be agreed on by all parties. A defendant cannot offer to settle to the judge and unilaterally drop the case. The parties make a settlement arrangement in lieu of going to trial, the defendant admits no wrongdoing, and parties agree to the amount of money to be paid and how it will be dispersed.

ORDER GRANTING IN PART DEFENDANT’S MOTION TO DISMISS

After the dismissal linked above, Reynolds filed this:

THIRD AMENDED COMPLAINT
AND DEMAND FOR JURY TRIAL

Where on page 17 you can see the alleged fraudulent charges. Though, ya know, I find it hard to see how a complete STD screen isn't 'necessary' or appropriate when a patient comes in suspecting she has a particular STD, since, if she's at-risk and having symptoms of one STD, she'd be at-risk for others. I also find it completely plausible that Self-Pay clients would opt not to have extra services, since 'self-pay' means they're paying completely out of pocket for services and probably can't afford a full panel of tests. It seems to me that these 'unnecessary' procedures are part of women's health and in the ideal scenario and best case scenario, women would have affordable, equal access to all of these procedures. Would you really argue that if a woman comes into a health clinic for a pregnancy test, that she does not also need contraceptive counseling and contraceptives? Since the fact that she may be pregnant means her contraception may not be the right contraception and/or might not be the most effective, or maybe she needs more education on the appropriate use of that method?

In both the Johnson and Reynolds cases, we see a disgruntled employee [in Johnson's case FIRED and LIED about what she saw] [in Reynold's case had been written up as disciplinary action at work, and in a position to lose her job] that worked for many years, according to their own testimonies, participated in alleged falsifications, yet waited until they were fired or in trouble to suddenly decide to report these alleged abuses. They also both stand to gain financially from such action. In Johnson's case, she became famous and a renowned speaker on the pro-life circuit. Both reek of retaliation and dishonesty. Neither can state specific cases of fraud.

tl;dr...but where did I ask for proof of Abby Johnson lying? I think you must have me confused with somebody else?

 

[nota bene]

The false charges allegations in the Catholic Healthcare link that yeat2late posted and I reposted took place in 1990s and they finally settled in 2011.

What does this have to do with the Gulf Coast PP having to pay $4.3 million to the state of Texas?

 

[sangha]

What does this have to do with the Gulf Coast PP having to pay $4.3 million to the state of Texas?

She was responding to mac, who implied that the length of time it took to come to an agreement suggested guilt

 

[SassySmartie]

tl;dr...but where did I ask for proof of Abby Johnson lying? I think you must have me confused with somebody else?

Here:

Did she lie? Evidence to support this character assassination? And as a whistleblower, while you're at it, did she lie then too? And was the Texas AG fooled? And was the $4.3 million-dollar judgment thus false?

 

[SassySmartie]

tl;dr...but where did I ask for proof of Abby Johnson lying? I think you must have me confused with somebody else?

Also, I find it funny how you refuse to read anything that refutes your assertions. I explained in the tl;dr how the settlement is not a judgement, how the entire case is suspect and how there was NO INVESTIGATION by either the Dept of Justice or the Texas AG's office. You've been presenting the information as if the settlement is a judgement following the AG's investigation finding fraud, it isn't. You're wrong.