"The medical care provided in abortion centers is Alabama is substandard.
"It is not required that doctors performing abortions be board certified, have hospital privileges, or carry malpractice insurance.
"No other area of medicine is practiced under such inadequate guidelines…
"As a physician, I feel ashamed that abortionists practice substandard medicine. As a woman, I am angry we are singled out for such shoddy treatment. So long as abortion is legal, it is negligent on the part of the state to allow this to continue."
Maria Johnson, M.D., Pulmonary/Critical Care Medicine, 2003
Lawsuit Alleges Overbilling by Planned Parenthood (2008)
The suit by a former executive of the group's L.A. affiliate alleges that state and federal agencies overpaid at least $180 million for birth control pills.
A whistle-blower lawsuit contends that Planned Parenthood affiliates in California overcharged the state and federal governments by at least $180 million for birth-control pills, despite internal and external warnings that its billing practices were improper.
In the federal suit, P. Victor Gonzalez says he was fired in March 2004 as vice president of finance and administration of the Los Angeles affiliate after raising concerns about the "illegal accounting, billing and donations practices of Planned Parenthood."
The alleged overbillings began in the late 1990s and continued until the Legislature changed the law in 2004 to allow Planned Parenthood to bill at a higher rate for oral contraceptives, said Gonzalez's lawyer, Jack Schuler.
A 2004 state audit of Planned Parenthood of San Diego and Riverside Counties -- one of nine affiliates statewide -- lends some support to Gonzalez's allegations. The report identified more than $5.2 million in overbillings just during the 2003 fiscal year.
Questions about Planned Parenthood's billing practices were raised as early as 1997 by a state Medi-Cal official, according to letters provided to The Times by Gonzalez's attorney. In October 1997 and January 1998, the official told Kathy Kneer, the organization's California chief executive, her affiliates were billing for oral contraceptives incorrectly.
State health officials now say,
however, that they do not believe Planned Parenthood acted improperly
because the organization was given contradictory guidance on billing
from the state.
In fact, after Planned Parenthood complained that a lower reimbursement
rate could imperil its survival, the state passed a law in 2004
allowing it to continue billing as it had been all along.
Former state Sen. Hannah-Beth Jackson of Santa Barbara said she sponsored the legislation to remedy the problem.
"I was told and persuaded that if Planned Parenthood had to reformulate
the charges . . . that they wouldn't be able to continue providing the
service, that they would be losing money," she said. "It was a question
of access, absolutely."
The whistle-blower suit, originally filed under seal in 2005, seeks
damages under the federal False Claims Act. It was made public this
week.
"Contrary to their national reputation as a prominent charity
organization and as a healthcare provider for reproductive services,
there is probable cause to believe Planned Parenthood's . . .
California affiliates have systematically engaged in fraudulent
overbilling against government funded programs," the suit says. Planned
Parenthood Affiliates of California spokeswoman Ana Sandoval declined
to comment Friday, saying the organization had not seen the lawsuit.
The case involves the arcane reimbursement rules of public health programs of the federal and state governments.
At issue is a federal program that allows health centers to buy common
drugs from manufacturers at a reduced price. In return for the
discount, the suit says, such clinics must follow specific rules for
seeking reimbursement.
The billing manual for California's Family Planning, Access, Care and
Treatment program, for example, says providers must bill "at cost" for
oral contraceptives.
Planned Parenthood, however, billed the government several times more
than it paid for the drugs, the lawsuit says, seeking what is known as
a "usual and customary" fee that allows for the cost of storing and
dispensing the drugs.
The state paid Planned Parenthood clinics more for every monthly pill
cycle dispensed, on average, than it paid other public and private
providers, according to a report commissioned by the state in 2004.
Planned Parenthood received an average of $11.99 for every cycle,
compared with $8.65 for other public healthcare providers and $8.26 for
private providers, the UC San Francisco Center for Reproductive Health
Research and Policy found.
While the state's 2004 state audit was underway, Gonzalez said, he
performed his own review of Planned Parenthood Los Angeles and found
similar problems: $2.1 million in overpayments during a one-year
period. He estimated that the agency made $100 per patient annually
from the "birth control pill markup alone," documents show.
Gonzalez said he tried to raise the issue with top officials
internally. The response was clear, he said: "They did not want to stop
the overbilling."
Schuler said his client intends to rely on internal Planned Parenthood
communications showing that officials worked tirelessly to lobby state
health officials to adopt the organization's point of view.
Officials at the state Department of Health Care Services say they do
not believe Planned Parenthood needs to repay any money already
reimbursed by the state.
[http://www.latimes.com/news/local/la-me-billing8mar08,0,4901401.story;
; Charles Ornstein, Los Angeles Times,
March 8, 2008]
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