Tuesday, August 11, 2009

Spokane PP overbilled Medicaid hundreds of thousands of dollars

Planned Parenthood Spokane Slapped with $700,000 Bill from Audit:

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

8 comments:

Foxfier, formerly Sailorette said...

I am shocked, shocked, to find gambling going on here....

Foxfier, formerly Sailorette said...

They find out, two to five years later, that there is massive federal fraud going on, to the point that the organization is being warned it could have the ability to bill to medicaid revoked-- and you want to claim it as a good thing?

When they also went out of their way to point out that this is by no means a full accounting-- it's just what they picked up in a smallish audit?

This is a bit like moving to the area of town that has the highest arrest rates, because there will be fewer criminals loose....

army_wife said...

Why am I not surprised? After all, look what a sterling example of honesty and good intentions Planned Parenthood is (*gag!*). They regularly lie to the whole wide world about what they do and especially exactly what abortion IS. Why should they not stoop to petty theft too? I guess they felt they hadn't pilfered enough tax money yet.

So who here thinks they are going to pay that $700k bill? I'm not holding MY breath. I think I'm more leaning towards PP's lawyers finding some sneaky legal contortions to get out of it. If that doesn't work out, I'm sure they can call in a few favors in Washington. I'm sure they have at least a *few* government officials that owe them favors.

Foxfier, formerly Sailorette said...

My sister had no idea what sort of group PP was until she got pregnant with her first.

They were listed under "pregnancy" with a big "pregnant? Not sure what to do? call us!" ad.

Phone call lasted about fifteen seconds, as the person on the phone tried to schedule my very aware-of-life sister for an abortion without so much as a by-your-leave.

army_wife said...

Now THAT is class! Let's assume every pregnant woman wants to kill her baby. Sheesh.

It's a good thing your sister didn't allow herself to be bullied into it. Some poor women don't have enough starch in their backbones (or perhaps sense in their heads) to keep others from bullying them into unwanted abortions. It's a shame and I'm sorry for those women. But kudos to your sister!

Foxfier, formerly Sailorette said...

Hehe, Mouse has been helping deliver calves since she was big enough to stay out of the way of dangerous animals; the usual BS about "tissue" wouldn't work on her, even before she got her medical massage training-- and she tells the story every time she gets even a slight chance.
None of the girls she works with will be caught by the same lies.
(Usually tells the story to folks holding her adorable little boy, or drinking beer with her identical-to-the-kid husband-- sis has always been better at getting to folks' gut.)

army_wife said...

I'm glad. :-) It's always nice to hear of other women who are spreading the TRUTH and educating others about this stuff.

I had an ultrasound a few weeks ago (about 11 weeks' gestation LMP) and the sonographer wasn't going to give me any pictures until I made her do it, because, in her words, "it's just a blob of baby at this point, anyway". I couldn't believe that someone who does ULTRASOUNDS for a living (for pete's sake!!) would even say that. What is she thinking?? I had just finished watching my "blob" putting its fingers into its mouth and bouncing all over the place - arms, legs, head, a little human. Not blob. Not "tissue". And this was at a regular OB appointment. Abortion wasn't even in the picture (I would never even consider it).

Foxfier, formerly Sailorette said...

Jiminitly, that's insane. I mean, I know they're not exactly as well defined as Tinkerbell or something, but neither am I at this point....

As a friend has said on a different subject: "Brain washed but good, huh?"