Thursday, August 20, 2009
Neither Planned Parenthood nor its attorney responded to inquiries, but DSHS spokesman Jim Stevenson told AIW late today that a notice of appeal was received by the government.
Planned Parenthood, the largest single provider of abortions in Washington, and the country, faces the risk of keeping the financial scandal in the news by appealing the ruling. But, on the other hand, paying the bill means admitting to the overbilling and potentially inviting further scrutiny into their finances and those of their affiliates across the state.
Details to follow as they become available.
Repeated inquiries to both Planned Parenthood and the group's attorney, David B. Robbins, have gone largely ignored. We have left numerous messages with Anna Franks, the acting president of PP of Spokane, asking what they plan to do. Ms. Franks, who runs PP of Central Washington, took over PP of Spokane about the same time the financial scandal became publicized, though she claimed the one thing had nothing to do with the other, according to the Spokane Spokesman-Review.
While Ms. Franks repeatedly described the audit as "routine" in her sole public statement on the issue, she has declined interviews, and claimed she was "strongly" considering appealing the findings. She did not give any indication as to which of the five separate categories of overbilling she disputed.
While Mr. Robbins is an expert at defending clients accused of Medicaid fraud, he suggested we not read too much into that, claiming he is equally experienced at helping clients with more basic Medicaid overbilling issues. (That was the only correspondence we received from him that even partially constituted an answer to our questions.)
We will find out by the end of the day whether DSHS has received a check, but either way, we are still eagerly anticipating word from Washington Medicaid director, Doug Porter, as to whether or not the state is going to bring fraud charges against Planned Parenthood, whether they are investigating other PP affiliates in the state for similar patterns of overbilling, and whether or not they are extending the overbilling investigation for Spokane beyond the period of the audit, which just covered three years from 2004 to 2007.
Perceptively, the Times linked the Spokane audit with the massive case of Medicaid fraud that Planned Parenthood was comitting over the course of many years in California.
While PPINW mulls an appeal, P. Victor Gonzalez, a former vice president of finance and administration at Planned Parenthood of Los Angeles, is pursuing a whistleblower lawsuit against PPLA on grounds that he was fired for speaking out about "illegal accounting, billing and donations practices of Planned Parenthood."
He is seeking $1.2 million in damages and says he has evidence that PPLA overbilled the state close to $180 million.
A state audit released in 2004 of Planned Parenthood of San Diego lends some credence to Mr. Gonzalez's allegations. It found the state made $5.2 million in overpayments in 2003.
There are two notable differences between the California case and the Spokane case. First, the California fraud primarily involved the 340B Drug Discount Program, in which PP purchased huge quantities of drugs at enormous discounts -- about $2 per unit for oral contraceptives and the abortifacient 'morning-after pill' -- under the federal 340B program, and then illegally billed Medicaid at standard rates, about $20, when the law clearly required them to bill at "acquisition cost".
The Spokane audit didn't contain any findings of 340B Medicaid fraud, but we are conducting a separate investigation of that. What we do know so far is that there was at the very least some confusion between the federal government and the Washington State government as to whether or not Planned Parenthood of Spokane was enrolled in the program.
The second difference was that in California, PP shockingly and successfully lobbied the state Medicaid department, known as Medi-Cal, to call off the audit before it was completed. This was revealed in the lawsuit. You are not supposed to be able to lobby to get an audit stopped, but there have been widespread allegations of corruption in California, and critics argue that the Medi-Cal bureaucracy is filled with individuals friendly with and sympathetic to DSHS.
The same allegations have been made about Washington, but it does at least appear that they were unable in this state to get the audit canceled.
Interestingly, Washington State's Medicaid director, Doug Porter, was the chief executive of Medi-Cal before he came here in 2000. The lawsuit, which has been explained in detail here, doesn't cover the period of Mr. Porter's tenure.
Tuesday, August 18, 2009
The state government has not said whether the group is still engaged in these types of overbilllings today, and has thus far declined to answer questions as to whether other PP affiliates in the state are guilty of the same practices. They have also not indicated thus far what they have concluded as to whether the overbillings were deliberate, rising to the level of fraud. So far no fraud charges have been filed.
The "Take Charge" program was started in 2001, at the beginning of George W. Bush's first term. An experimental program, it required the permission of the federal government to get started, and needs the feds' review for re-authorization every three years. The initial trial ended in 2006, when it was renewed, despite objections.
"Free Birth Control For a Year"
The premise of the program is simple. Extend Medicaid coverage for birth control to more people by relaxing the income qualification threshold. The result is free birth control for a year for qualifying individuals, mostly women.
It is a fundamental and unquestionable dogma of the sexual left that putting women with dark skin on birth control is A Very Good Thing. Taking oral contraceptives is perhaps the closest thing our cultural Marxists have to a sacrament.
While theoretically any health care provider can sign up to be a "Take Charge Provider" -- i.e., someone who signs individuals up for the program, administers an exam, and provides them with birth control -- it didn't take long for Planned Parenthood affiliates across the state to position themselves as the primary face of the initiative.
Half of Planned Parenthood Clients are Take Charge
A review of Planned Parenthood of Western Washington's finances since 2000 shows a doubling of the revenues since the program began, from about $15 million a year, to about $40 million in revenues each year today! Their annual report freely admits that half of their clients are Take Charge enrollees.
We have conducted an exhaustive review of the Take Charge program, including interviews with Washington State and federal officials who oversee it. The overall objective of the program is to reduce the financial burden on Medicaid of all the birth expenses it pays for. If all these women who end up having babies at Medicaid's expense could be put on birth control, the thinking goes, Medicaid will save money.
Has it worked out that way? You be the judge: just before the program began, in 2000, Medicaid was paying out $200 million for childbirth expenses. Five years later, when the program came up for review and was approved for 3 more years, you might expect that this number had gone down. In fact, that figure had jumped 50% to a staggering $300 million!
The number of births paid for by Medicaid had gone up from about 33,000 to 40,000.
Program Has Led to Expansion of State Abortion Chain
Unfortunately, not all pregnancies end in birth. What about abortion? Since Take Charge began, while the overall abortion rate has declined slightly, the rate amongst Medicaid-eligible Washingtonians has jumped from just over 40% of all abortions to just under 60%.
As we've noted, the largest single gateway for Take Charge clients is Planned Parenthood. Not only have they made literally tens of millions of dollars off the program from birth control sales, their abortion business has mushroomed. They are doing 50% more abortions now than just 3 years ago. While they refuse to make abortion figures for 2000/2001 available, by any estimate they are doing more than twice as many abortions as they were when Take Charge began.
Brian Cutler, spokesman for Planned Parenthood of Western Washington, even admitted to us that they had used the windfall revenue from Take Charge to "upgrade" existing clinics -- including adding "abortion services" -- and to open new ones. In other words, Take Charge money has been used to open abortion clinics.
We confronted state DSHS and federal HHS officials who oversee this program with all this information. The state government has shown little to no interest in addressing our concerns. The federal government did hold a conference call with us to discuss the matter, but provided no meaningful assurances as to how this situation would be remedied.
Breaking the Law?
As if this were not enough, there are two additional matters. Federal law requires that these kinds of experimental programs, known as "Section 1115 Waivers", must be revenue neutral. In other words, the cost of the program -- all that "free" birth control -- must be balanced by savings in terms of births avoided. Nowhere in the Take Charge Final Report presented to the federal government in 2006 did the report's author, Dr. Leslie Cawthon, provide a figure indicating the financial cost of the program, let alone demonstrate its revenue neutrality.
Requests for these figures have been unmet. DSHS may have opened itself up for a lawsuit. We will be following up on this.
Finally, we have asked the federal government point blank: is the goal of the program to reduce the cost to Medicaid by reducing the number of births, or reducing the number of pregnancies? Clearly the former can be achieved through abortion, Planned Parenthood's specialty. The latter cannot. If the only measure is cost, since abortions are cheaper than childbirth, then the current situation would be perfectly acceptable to them. No-one was willing to provide a definitive answer to this question. This is an outrage.
We have called on the government to make it explicit that the cost-saving goals of the program must not be met through abortion. The only way to do this is to require unequivocally that no Take Charge provider can also be an abortion provider.
A long-serving state senator from Western Washington told us off the record that DSHS was so corrupt and "in bed with" Planned Parenthood that there was simply no chance that any program providing so much revenue to the abortion chain would be cut. We shall see soon enough if known Medicaid abusers get their primary source of revenue rubber-stamped.
Monday, August 17, 2009
John Stucke, the Spokesman-Review reporter, was able to secure an interview with Washington State's Medicaid director, Douglas Porter. Whereas our report relied on the written report, Mr. Stucke's story relied heavily on his interview with Mr. Porter. It was, perhaps, not unreasonable for Mr. Stucke to trust Mr. Porter's explanations, but it turns out that resulting article was very confusing.
In the Spokesman Review piece, which was subsequently picked up and retransmitted by the wire services, Mr. Porter claimed that the audit primarily found that Planned Parenthood "required unnecessary office visits by its poorest patients."
"At Planned Parenthood," said Mr. Porter, "Medicaid [birth control] patients were coming in every month," instead of every 6 to 12 months.
What is odd, though, is that the written audit report makes no mention of this issue. Rather, it called out 5 categories of overbilling, only one of which pertained to office visits, and the issues there were billing certain types of visits, like picking up a prescription, under more lucrative billing codes, or billing for visits for which there existed no chart notes.
Mr. Stucke indicated to us that he did not press Mr. Porter on this apparent discrepancy between this part of his interview and the written report. We have contacted Mr. Porter's office ourselves, but have been redirected through the public disclosure office. We have been promised a response, and will report on on our findings if and when that response arrives.
Those familiar with Planned Parenthood's clinical practices would be surprised to hear claims that the organization was guilty of spending too much time with birth control clients. Critics have long charged that the organization hands out birth control "like they were chicklets", and one reason the abortion business is so popular with the young and promiscuous is because they are a quick, easy, and "non-judgmental" source of protection from the consequences of "weekend fun".
Any time a health care provider is accused by an insurer of billing too many office visits, they usually jump to a standard defense that "this is what proper health care requires" and accuse the insurer, public or private, of not paying for proper care. Even Planned Parenthood itself, never one to miss a rhetorical opportunity, failed to make this claim.
The Spokesman Review did correct one thing since we contacted them. They originally titled the piece: "Clinic overbilled Medicaid," as is still evident from the URL. We pointed out that Planned Parenthood of Spokane operates five separate clinics. The headline was changed to "Planned Parenthood overbilled Medicaid."
Another odd thing about the Spokesman-Review report was that, at the very end, it did report that Mr. Porter said the audit found that "drug prescriptions were being changed by unauthorized staff," and that Mr. Porter considered this to be of "equal" importance to the too-frequent-visit issue. Yet the newspaper only dedicated one more sentence to the issue, the last -- and least read -- line of the whole article.
Wednesday, August 12, 2009
Ms. Franks repeatedly referred to the audit as "routine". Most of the release was a regurgitation of the "dates and dollars" of the audit.
Beyond trying to cast the audit as "routine", she said:
"It was clear in the audit findings that services had been provided; however the State auditor thought the documentation was incomplete."This, in fact, is not true. It's interesting that Ms. Franks raised the issue of whether they had billed for services that were never rendered, because so far this hasn't been discussed. The fact is, it's pretty much impossible for an auditor to determine if services were rendered, without interviewing clients, etc., which was beyond the scope of this type of investigation. All the auditor can do is see if there are chart notes corresponding to services that were billed. The existence of chart notes does not, however, prove that the services were actually provided, of course.
And in fact, much of the findings in the audit were that PP Spokane billed Medicaid for services for which there were no supporting chart notes. They did not, interestingly, discuss whether or not the procedures had actually taken place. Perhaps that is still under investigation.
As for the supposedly "routine" nature of the audit, again we think Ms. Franks protests too much. There's nothing routine about a $630,000 bill. There's nothing routine about doling out birth control without a prescription. There's nothing routine about billing Medicaid for condoms at three times the legal rate. There's nothing routine about billing Medicaid for doctor's visits that were never documented. There's nothing routine about unbundling abortion services.
As for the future, all she said was that "PPINW is strongly considering an appeal of the audit findings."
Ms. Franks, meanwhile, has declined to answer questions from the media, including the Spokane Spokesman-Review. Some critics believe this sort of defensive behavior does not bespeak confidence.
AIW has also attempted repeatedly to solicit information from her attorney, Mr. Robbins (pictured left), but his responses have been unhelpful at best, rude at worst. At first he simply demanded to know "who pays you?". We thought he might at least tell us when he had been hired by Planned Parenthood Spokane, but he dismissed the question with a "of what relevance is that?"
He did suggest, though, that his presence as an attorney for Planned Parenthood should not be interpreted as a sign that they fear a fraud charge. All of this behavior is raising more questions than it is answering.
Tuesday, August 11, 2009
Sunday, August 09, 2009
Planned Parenthood of Spokane (PPS) has been caught overbilling Medicaid for condoms, charging for contraceptives without a prescription, "unbundling" abortion claims, and claiming patients were having doctor visits when they were just picking up a prescription.
All of this is in an audit of the organization just completed by the Department of Social and Health Services (DSHS). And as a result, PPS has been ordered to reimburse the government $630,000 plus interest for the overpayments. The audit did not get into the question of whether the overbilling was part of a systematic fraud scheme, but it also was clear that if this practice continued PPS would lose its Medicaid billing priveleges.
The audit found 5 categories of overbilling:
1) Numerous examples of billing Medicaid for oral contraceptives either without any underlying prescription for the drugs, or where the prescription was completely invalid, e.g., "Continue with drug XYZ".
2) Many cases where male condoms were billed at some nicely rounded up price instead of the actual acquisition price, as has been required since 2003. For example, in some cases they billed Medicaid $3.00 where the invoices clearly showed that PPS paid $0.84. In other cases, they billed $2.00 where the invoice showed the acquisition price was $0.56.
3) Unbundling post-abortion antibiotics and billing them to Medicaid under Family Planning, which is strictly prohibited.
4) Billing office visits to pick up a prescription or get an injection as "Evaluation and Management" -- a sit-down consult with a doctor or ARNP, and which have a higher reimbursement rate, in some cases double.
5) Billing for pregnancy tests which were done when the client never even suspected she was pregnant, and without any indication of medical necessity.
The audit covered the three-year period from Spring 2004 through Spring 2007, and made a point that it didn't claim to have been exhaustive, meaning that PPS shouldn't assume that they are free and clear if they are guilty of additional overbilling from this period not discovered in the audit.
The audit didn't address the question of whether these practices were going on prior to 2004, or after 2007, including up to the present, or the question of whether it was systematic and intentional, thus rising to the level of fraud.
If it's any indication, though, PPS has lawyered up and hired a fancy Medicaid fraud expert from Seattle to defend itself. The audit was addressed to David B. Robbins, with Bennett Bigelow& Leedom. Mr. Robbins was "selected for inclusion in the 25th Anniversary Edition of The Best Lawyers in America 2008 Edition," according to his website. That can't be cheap.
The audit itself also didn't deal with the question of who is going to ensure that these overbillings are not going on right now.
There is also the question of whether these practices are common to the other Planned Parenthood affiliates in the state, including PP of the Great Northwest (formerly Western Washington), and PP of Central Washington, and whether this audit will trigger audits of the sister organizations.
The audit made it into the news back in June when it was reported in the Spokane Spokesman-Review. The organization's then president was removed, and the group is reportedly being run by Anna Franks, president of Planned Parenthood of Central Washington, which is right now trying to expand into Pasco. But there's nothing to indicate that her practices are any different from the Spokane-centered affiliates.
A $700,000 bill would be a bitter pill for most "non-profits", but with over $11 million the bank, PPS can easily afford it. How did a supposed not-for-profit get into such a comfortable financial situation? Some critics argue that this huge cash reserve has been generated through schemes uncovered in this audit, and that there is more to be discovered.
In 2005, for example, they reported $2 million in profits off of total revenue of $6 million. That's a 33% (net) profit margin for a non-profit.
Some might argue that Medicaid billing is complicated and errors are inevitable. But no organization on earth should have more expertise in how to bill Medicaid correctly for contraceptives than Planned Parenthood.
In the days ahead, this blog will be contacting representatives of Planned Parenthood for comment, as well as representatives of the government to get answers to some of these questions.
The audit didn't mention what prompted the government to initiate this investigation in the first place.
View the Audit Documents here.