The good people at Alliance Defending Freedom have forwarded me the settlement agreement between Planned Parenthood Gulf Coastand the United States of America, the Texas Attorney General, and whistleblower Karen Reynolds, for charges that PPGC committed Medicaid fraud between 2003-2009. The settlement was signed by all parties on July 24 and 25.
As I wrote yesterday, PPGC has agreed to pay $4.3 million. According to the settlement, the money will be divied three ways:
$2,552,169 – United States
$1,247,000 – Karen Reynolds (bounty)
$500,831 – State of Texas
In addition, PPGC must pay Reynolds’ attorney fees. Reynolds was represented by the American Center for Law and Justice.
ADF attorney Casey Mattox was kind enough to walk me through the settlement agreement. Following are the high points, including a few bombshells.
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 aPlanned Parenthood affiliate of fraud.
That it was Barack Obama/Eric Holder’s DOJ makes this even more newsworthy.
The WHP is the very program PP had the audacity to kick and scream about being evicted from last year, when all along at least one of its affiliates was defrauding it.
In the settlement PPGC denies the allegations are true.
But as Mattox said, “If you believe a Planned Parenthood affiliate that has been fighting against defunding efforts, threatening lawsuits over its exclusion from the Women’s Health Program, has another Medicaid fraud case pending in federal court [Abby Johnson's], and claims recently passed pro-life legislation is forcing it to close clinics, would pay $4.3 million just to make this case go away, I have depreciating property I’d like to show you. If PP really believed these claims were baseless, this was their chance to demonstrate that in court. Instead, they paid out a huge chunk of money.”
The settlement clearly stipulates both the State of Texas and federal government believe PPGC billed false claims.
Another huge component of the settlement is that PPGC has 90 days to identify overcharges it has made against the government and Medicaid and repay the overcharges, plus interest and penalties.
Other noteworthy points in the settlement:
- The Inspector General and DHHS reserved the right to investigate other claims against PPGC (Abby Johnson’s lawsuit, for instance).
- The government (state/federal) reserved the right to sue for civil or criminal liability, including “current or former directors, officers, employees, agents, or sharehoolders of PPGC.”
- The government reserved the right to audit PPGC’s books for overcharges.
- PPGC cannot turn around and charge former patients or insurers for government overcharges.
- PPGC agreed to cooperate with any government investigation and turn over requested unredacted documents and reports. PPGC cannot impair employees from cooperating with the government.
- If for some reason PPGC reneges on this settlement, such as by declaring bankruptcy, the government will increase the amount PPGC owes to “$6,432,560, which represents three times the amount the Government alleges to have be overpaid.”
The latter point means the government believes it can prove it found $2,144,186.67 million in overcharges by PPGC.
So PPGC’s $4.3 million settlement is for twice that amount. Reynold’s lawsuit alleged PPGC overbilled “several millions of dollars” over the course of six years. Mattox believes the $30 million figure mentioned by news outlets included penalties.
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The amount of waste, abuse, and fraud uncovered in Planned Parenthood affiliates nationwide now totals over $12.5 million, according to Mattox. Auditors and investigators in several states have uncovered Planned Parenthood affiliate fraud.
That the federal government has identified Planned Parenthood as submitting false claims should impact the ongoing congressional hearing, said Mattox, and also help states trying to defund Planned Parenthood.
Mattox said it will be interesting to see the amount of Medicaid funds Planned Parenthood receives over the next 2-4 years. It should be tightening up its act.
We may already be seeing it. RH Reality Check complained yesterday:
[C]laims in [the] Texas Women’s Health Program, which replaced the Medicaid Women’s Health Program at the start of this year, have declined by about 23% in the first five months of 2013, as compared to Medicaid Women’s Health Program claims during the same period last year. This is the first year the program has operated without Planned Parenthood.
RHRC was trying to claim that fewer low income women are being served. But the lower number more likely represents claims not padded by Planned Parenthood.
“It is hard to calculate the impact these lawsuits are having,” said Mattox. They are forcing Planned Parenthood to make voluntary changes in its billing practices. My biggest hope is this will hurt Planned Parenthood by taking the Teflon off.
“Planned Parenthood knows it now has people looking over its shoulder,” Mattox said. “I can guarantee you PP went into this with the mindset, ‘How much can we bill and get away with?’ Now PP’s mindset is, ‘What can I defend to a judge?’”
This article originally appeared on JillStanek.com and is reprinted with permission.