A recently unsealed federal whistleblower lawsuit accuses Planned Parenthood Gulf Coast of turning in over 87,000 reimbursement claims to Medicaid that were either “false, fraudulent, or ineligible.” Abby K. Johnson, the plaintiff, is an ex-director at one of the defendant’s clinics. She says she had “system-wide” access to billing activities and the records of patients for approximately two years.
Per her whistleblower complaint, the fraudulent reimbursement claims were made by all of Planned Parenthood Gulf Coast’s 10 clinics. The claims were submitted to the Texas Women’s Health Program, which is the Medicaid program in that state. Johnson contends that even though only office visits having to do with the management of contraception were reimbursable under the contract between her former employer and the Medicaid program, staff proceeded to submit for other services, such as Pap tests, STD tests, and pregnancy tests.
Johnson is accusing the higher ups of acknowledging the fraud that was going on. Meantime, staff allegedly modified patient charts to conceal the Medicaid fraud. Also, although by law Planned Parenthood Gulf Coast is supposed to refer women who are pregnant to clinics or doctors that do not conduct or advocate for elective abortions, the organization would send these patients to its own abortion clinics. (Johnson is a pro-life activist.)
If you suspect Medicaid billing fraud, you should know that as a private citizen you may be able to submit a whistleblower lawsuit on behalf of the government. Not only that but under the False Claims Act’s qui tam provision, whistleblowers can be entitled to a percentage of whatever is recovered (up to 30%.)
That said, submitting a Massachusetts Medicaid billing fraud lawsuit is a complex process and you will want to make sure that you are represented by a Boston injury lawyer that is experienced in handling this type of whistleblower case.
More Blog Posts:
WellCare Health Plans Settles Whistleblower Lawsuits in Medicare/Medicaid Fraud Case for $137.5 Million, Boston Injury Lawyer Blog, April 2, 2012
$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 5, 2012
Qui Tam Cases Result in $2.B Recovered in 2011, Boston Injury Lawyer Blog, January 4, 2012