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New York Whistleblower Lawyer Blog: Planned Parenthood Accused of Medicaid Fraud

Thumbnail image for Thumbnail image for Thumbnail image for above-the-bar-logo.jpgA former employee at Planned Parenthood Gulf Coast (“Gulf Coast”), a facility in Texas, has a filed a federal whistleblower action alleging that a local affiliate has violated the False Claims Act by defrauding the government of millions of dollars using Medicaid claims. Her lawsuit also alleges widespread and systemic fraud by the company. Fraudulent medical claims have a substantial impact on the government and you as a taxpayer. If you know of any improper billing practices involving Medicaid claims, contact our New York Whistleblower Attorneys at (800) 894-9645 to learn if you can seek a monetary reward.

A non-profit organization filed this qui tam whistleblower complaint in 2009 on behalf of Abby Johnson, a former facility director at Gulf Coast. Johnson’s position gave her “system-wide” access to patient records and billing activities for about 2 years. She claims that she wanted “to simply expose Planned Parenthood and expose their corruption, and expose what they are doing with American tax dollars.”

The lawsuit was kept under seal until last Friday when a District Court Judge made some of the filings public. The suit charges Gulf Coast with submitting over 87,000 reimbursement claims for services that were “false, fraudulent, and/or ineligible.” Johnson alleges that 10 clinics run by Gulf Coast put in fraudulent claims worth about $5.7 million to the Texas Women’s Health Program, which is the state Medicaid program.

The lawsuit alleges that Gulf Coast had a contract with the state to help prevent unwanted pregnancies to eligible women. The clinics offered eligible women an annual family planning exam and consultation. However, only office visits “related to contraceptive management” were reimbursable by the Medicaid program. The complaint charges Gulf Coast leaders and staff of collaborating to register all of kinds of ineligible services for Medicaid reimbursement, such as pregnancy tests, sexual disease tests, and Pap tests. Johnson alleges that the company admitted that these claims were not eligible for reimbursement but told clinic directors that “We have to keep these people as patients” and “We must turn every call and visit into a revenue-generating client.” The lawsuit alleges that clinic staff made false notations on charts to cover up fraud when inspectors or auditors were coming.

The False Claims Act calls for civil penalties of $5,000 to up to $11,000 per claim plus three times the amount of damages for anyone who knowingly submits any false, fraudulent, or ineligible claims to the government for payment. The qui tam provision of this Act allows an individual to bring an action on behalf of the government if she or she has information of fraud being committed against the government. Because of the complicated nature of the statute, the Act requires that in order to file an action, you must be represented by an attorney. Depending on whether the government intervenes in your action, you may recover anywhere from 15% to 30% of the government’s recovery.

If you are a physician, nurse, or a healthcare worker, make sure the hospital, facility, or physicians practice you work at is not compromising patient care and violating the federal False Claims Act by improperly filing fraudulent claims under Medicare or Medicaid to make more money. Not only is healthcare affected but every taxpayer ends up footing the bill for fraudulent claims. If you know of fraud being committed against the government, call our Whistleblower Attorneys at Villanueva & Sanchala at (800) 893-9645 to figure out if you have a claim under the False Claims Act.

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