Former Employees Allege Planned Parenthood “Fixes” Patients’ Charts to Hide Illegal and Improper Practices
“We believe in open and honest communication,” claims Planned Parenthood Gulf Coast (PPGC), the nation’s fourth largest Planned Parenthood affiliate, which operates ten clinics in the state of Texas and two in Louisiana.[i] Whether that belief in “honest communication” extends to information PPGC is required to share with the government is seriously challenged by two recently unsealed lawsuits. In addition to the claims of fraudulent billing that were outlined in yesterday’s exhibit, the “whistleblower” suits filed by former PPGC employees allege that the affiliate had a corporate-wide policy of “doctoring” charts to increase revenue—to the detriment of its patients and at the expense of taxpayers.
Among her claims, Ms. Karen Reynolds (a “Health Center Assistant” at PPGC for nearly a decade) alleges that PPGC’s “employees routinely altered the chart to match the bill” where “a patient’s chart did not contain documentation to support services marked on the bill.”
Falsifying information on patients’ charts was the corporate policy of Planned Parenthood, according to Ms. Reynolds. It was not mere oversight or the work of rogue employees. In an effort to evade detection of improper and fraudulent billing practices and failure to comply with the law, PPGC employees were allegedly trained to “fix” its charts—specifically, to remove or alter information relevant to claims submitted to the government for reimbursement.
Ms. Reynolds, who worked at PPGC for almost ten years, states that PPGC routinely “fixed” charts. In her experience, Ms. Reynolds estimates that
[A]pproximately 1/3 of the patient files would contain charges on the super bill[ii] with no underlying documentation in the patient’s chart to indicate the corresponding service was ever performed.[iii]
According to Ms. Reynolds, when a bill did not reflect the services documented in a patient’s chart, employees were instructed to “fix” the chart to match the bill.[iv] This was, according to Ms. Reynolds, “standard practice at PPGC clinics” during the entire time of her employment.
That “standard practice” of doctoring charges, as Ms. Reynolds contends, was an intentional corporate policy. “PPGC trained its employees to create false and misleading patient chart entries” in order to support reimbursements for services which were not permitted under the Texas Women’s Health Program (WHP) or Medicaid, including “obtaining payment for abortion-related services.”[v]
In August 2012, a federal district court found that the facts as alleged by Ms. Reynolds “create a plausible claim for relief” under both the federal False Claims Act and the Texas Medicaid Fraud Protection Act.[vi] The court rejected Planned Parenthood’s attempt to have this case summarily dismissed. It will now proceed to trial.
Shortly after Ms. Reynolds filed her lawsuit against PPGC, Ms. Abby Johnson brought another “whistleblower” suit against PPGC with allegations of chart “fixing” that buttress Ms. Reynolds’ claims.
Ms. Johnson, who worked at PPGC’s Bryan Clinic in Bryan, Texas from September 2001 until she resigned in October 2009, similarly details that Planned Parenthood employees were expected to and did alter information on patient charts to conceal its failure to comply with the law.[vii]
Ms. Johnson recounts the existence of a systemic chart-fixing scheme at PPGC clinics. Her complaint states that PPGC would “pre-select” and “purge” its client files to make them appear to be in compliance with state and federal law and regulations.[viii] Ms. Johnson alleges that where disparities existed between billing documents and patient charts, PPGC employees “were instructed by members of [PPGC’s] Key Management Team[ix]…to ‘make it right’ by fixing charts before auditors arrived.”[x]
Notably, Ms. Johnson relates that even after clinic managers were made aware that PPGC was improperly billing the Texas WHP program for products and services not covered under that program, she and other managers were “instructed…to continue to seek Texas WHP-eligible reimbursements by falsely notating the patient charts of women with infections to indicate that Texas WHP-eligible services had been provided, when, in fact, Texas WHP-eligible services had not been provided to such women.”[xi]
In addition to altering patient charts to hide improper and fraudulent billing practices, Ms. Johnson alleges that because PPGC knew about its “audits in advance,” it altered its charts to cover up their failure to comply with state laws and policies designed to protect minors and vulnerable women, such as Texas’ parental consent law.
Ms. Johnson alleges that members of Planned Parenthood’s Key Management team instructed PPGC staff to provide auditors with charts that had been “fixed” to ensure that “required documentation, especially with regard to parental consent and non-coercion, was included in each client file.”[xii] Such a disregard for parental involvement and non-coercion laws endangers the health and safety of America’s women and young girls.
If these allegations are true, for Planned Parenthood, “right” appears to be synonymous with what is best for its bottom-line, not what is legal, fiscally responsible, or in the best interest of America’s women and girls.
[i] See Who We Are, Planned Parenthood Gulf Coast, http://www.plannedparenthood.org/gulf-coast/who-we-are-33227.htm (last visited Oct. 17, 2012).
[ii] A “super bill” is an itemized form used by healthcare providers for reflecting rendered services to be submitted to payers (insurances, funds, programs) for reimbursement.
[iii] Third Amended Complaint at 21, United States and Texas ex rel Reynolds v. Planned Parenthood Gulf Coast, No. 9-09-cv-125 (E.D. Tex. Oct. 28, 2011).
[iv] Reynolds Complaint at 21.
[v] Id. at 15.
[vi] See Reynolds v. Planned Parenthood, (E.D. Tex. Aug. 10, 2012) available at http://c0391070.cdn2.cloudfiles.rackspacecloud.com/pdf/reynolds-motion-to-dismiss-order.pdf (last visited Oct. 17, 2012).
[vii] Alleged violation of the False Claims Act, 31 U.S.C. § 3729(a)(1)(A), (B), and (G) and the Texas Medicaid Fraud Prevention Act, Tex. Hum. Res. Code Ann. § 36.002(1), (2), (4)(B), (and (12).
[viii] Second Amended Complaint at 35, United States and Texas ex rel Johnson v. Planned Parenthood Gulf Coast, No. CV-H-cv-3496 (S.D. Tex. Dec. 20, 2011).
[ix] Ms. Johnson’s complaint identifies “Planned Parenthood’s Key Management Team” as PPGC’s authorized officers, managers, and agents including Melaney Linton, PPGC’s Chief Operating Officer; Laurie McGill, PPGC’s Vice President; Bonnie Smith, PPGC’s Vice President of Medical Services; Sandra Smolensky, PPGC’s Regional Director of Medical Services; and Dyann Santos, PPGC’s Regional Director of Medical Services.
[x] Johnson Complaint at 37.
[xi] Id. at 36.
[xii] Id. at 37.