intersection

From the Lufkin (TX) News:

Planned Parenthood Gulf Coast is a defendant in a federal lawsuit after a former Lufkin clinic employee alleged a multi-million-dollar billing scheme….

The updated complaint, filed in October 2011, alleges that while [Karen] Reynolds [former employee] was employed as a health center assistant, she was instructed by the organization to maximize billing revenue when the government was fitting the bill through Medicaid and the Women’s Health Program.

She claims this was the procedure in all 12 Planned Parenthood Gulf Coast locations across Texas and Louisiana.

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….

Read it all, and read the entire complaint is here, thanks to Jill Stanek. From the complaint:

Fraudulent Patient Chart Documentation to Obtain Reimbursement for Unqualified Services

30. Defendant PPGC also trained its employees to create fraudulent and misleading patient chart entries so as to obtain reimbursement for services for which WHP and Medicaid would otherwise not allow payment. 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.
(Emphasis added).

31. A second memorandum given to employees in February 2009, in preparation for a Department of State Health Services audit, was even more explicit in instructing employees on how to fraudulently bill WHP, Medicaid, and other government programs for post-abortion patient visits, including an express instruction to document in a patient chart that the reason for the patient’s visit was to have the Well Woman Exam when in truth the patient had clearly indicated the purpose of the visit was a post-abortion follow-up.

POST AB VISITS:
On the telephone – if client requests post-ab check, tell her that service is a self-pay service and quote price. Ask if she wants other services during the visit – especially a birth control method. If yes, screen her for WHP or Title XX eligibility for the birth control part of the visit.

Make sure that if the visit is being paid for by Title XX, Medicaid, or WHP that it is a birth control focused visit with a note in the subjective section that the client has an abortion “x” weeks ago. Example: Client here for WWE and to start on “x” BCM. States had surgical (or medical) abortion “x” weeks ago.
(Emphasis in original).

Trial is set for April, 2013.