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.
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 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.
HT: Suzy B