A Texas Planned Parenthood affiliate allegedly defrauded the state’s Medicaid program to the tune of $5.7 million, according to a federal “whistleblower” lawsuit that was unsealed last Friday.
The lawsuit filed in July 2010 by Planned Parenthood clinic director turned pro-life activist Abby K. Johnson, suggests that Planned Parenthood Gulf Coast filed 87,075 “false, fraudulent and ineligible claims” for Medicaid reimbursement to the federal government and the State of Texas.
Johnson, who made national headlines in October 2009 following her decision to quit as head of a Texas Planned Parenthood clinic, filed the lawsuit in the Federal District Court of the Southern District of Texas under the Federal False Claims Act and Texas’s Medicare Fraud Protection Act. These laws allow private citizens with knowledge of fraudulent activity against the federal government to bring suit on behalf of the government.
Under the state and federal laws, the state attorney general and U.S. Justice Department is required to investigate the case, but are not required to prosecute the case.
According to Alliance Defense Fund attorney Michael Norton, who represents Johnson in this case, the Texas attorney general has stated he is reviewing the allegations but has not decided whether he will intervene. Nor has the Justice Department made any determinations.
“Everyone, no matter what you think about abortion, should be interested in where our money is going and how it is being spent,” Johnson said. “As someone who saw the inside of this and saw the fraudulent billing and the fraudulent claims, I felt like I had a duty, and it was necessary for me to come forward with this information.”
The lawsuit suggests that Planned Parenthood Gulf Coast fraudulently billed the state and federal governments for procedures it was not entitled for reimbursement for between 2007 and 2009.
Planned Parenthood Gulf Coast officials did not respond to a request for comment.
According to court documents, Planned Parenthood is only entitled for Medicaid reimbursements for providing contraceptives to patients; however, the Texas affiliate’s management allegedly saw fit to illegally bill the state and federal governments for other services.
These illicit services included screenings for sexually transmitted diseases, pap smears and pregnancy tests.
Johnson alleges in the lawsuit that 40 percent of all patient visits or procedures were fraudulently billed in 2009 alone, costing taxpayers over $1.2 million.
Planned Parenthood officials reportedly knew this was going on and altered charts to trick Texas state officials into thinking that the abortion and family-planning provider was following the law.
Johnson asked her supervisor Dyann Santos, the regional director of medical services at Planned Parenthood Gulf Coast, what would be done with the ill-gotten funding.
“Well, we are going to hope we don’t get caught,” Santos replied according to court documents.
Court documents allege that Planned Parenthood management subsequently ordered their spreadsheets and other relevant altered its files to make them appear as if they were compliant with Texas law. That way they would be able to evade the state auditors.
Norton says Johnson’s standing in the case is based in the fact she was a first-hand observer of the alleged waste, fraud and abuse.
Johnson left Parenthood after watching an ultrasound of an unborn child being dismembered before her eyes, an ultrasound that reminded her of what she had when she was pregnant with her daughter.
She subsequently wrote a book titled unPLANNED about her experience and rose to national prominence as a pro-life crusader.
If Johnson’s lawsuit is successful, she could personally stand to receive between 10 and 30 percent of the settlement and the Planned Parenthood affiliate could receive significant fines and penalties.
Norton anticipates that Planned Parenthood will work to either have the lawsuit tossed out of court or have its scope curtailed, but he suggests the scope of the possible wrongdoing could exceed what his client has alleged because money is fungible.
Johnson’s lawsuit is not alone in alleging that Planned Parenthood engaged in Medicaid waste, fraud and abuse.
The California case of Gonzales v. Planned Parenthood alleges that a local Planned Parenthood affiliate engaged in false billing practices of Plan B abortion drugs. The Texas case of Reynolds v. Planned Parenthood also alleges Planned Parenthood Gulf Coast billed Medicaid patients for services were not rendered or reasonably medically necessary.
