August 12, 2009 in City

Audit: Planned Parenthood overbilled Medicaid

Review also faults clinic’s drug distribution practices

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Planned Parenthood of the Inland Northwest required unnecessary office visits by its poorest patients, a practice that led to excessive payments from the taxpayer-financed Medicaid program, according to a recent audit.

The audit also uncovered troubling billing procedures and problems with unauthorized staff prescribing and dispensing birth control pills, said Doug Porter, Washington’s Medicaid director. Medicaid covers the medical bills of poor people throughout Eastern Washington and North Idaho.

The issues amounted to excess Medicaid payments to the clinic totaling $629,143. Interest of 1 percent per month will begin accruing Aug. 20 if the clinic fails to repay the state.

Over the three years the audit covered, the clinic collected about $7.7 million from Medicaid.

Planned Parenthood is considering an appeal of the audit findings. The clinic’s chief executive officer, Anna Franks, declined an interview request.

The audit reviewed 333 procedures performed from March 15, 2004, to Feb. 26, 2007.

Based on the review, the auditors applied the sample findings to all 267,815 procedures performed during that time to calculate the overpayment.

The audit was launched after staff with the Washington Department of Social and Health Services grew suspicious of the frequency of clinic visits by Medicaid patients.

“Most birth control clinics will see a woman and usually determine what method of birth control is best and then they will prescribe six months to a year right then and there,” Porter said.

At Planned Parenthood, he said, Medicaid patients were coming in every month.

Porter said he could not disclose whether he referred the finding to Medicaid fraud investigators with the Washington Attorney General’s Office.

It is the second set of problematic findings in two years.

A less formal review of Planned Parenthood’s Medicaid billing practices last year found that the clinic exceeded typical numbers of visits by women with complicated medical histories.

“The review found that the clinic was improperly billing for lots and lots of women who didn’t have that complication profile,” Porter said.

The clinic repaid $10,800 to Medicaid as a result.

In a written statement, Planned Parenthood called the audit “routine” and said it would not affect patient services.

Planned Parenthood has not been fined and no patients were harmed by the practices that the audit determined ran afoul of state regulations. The clinic provides contraception, family planning, women’s health care, abortions and other medical services.

The audit determined one billing problem associated with Planned Parenthood’s abortion practices. The clinic charged separately for an antibiotic that was already bundled with a group of medicines included in the abortion procedure.

The clinic earlier this year downplayed the significance of the audit.

“(Medicaid) audits are happening all the time. This one is no different,” Planned Parenthood spokeswoman Jet Tilley told The Spokesman-Review in May.

About 30 clinics across the state are audited each year by Medicaid staff. The overbilling by the local Planned Parenthood is considered significant, Porter said.

“What we hope is that $630,000 is enough tuition to be smarter about how they operate and do business,” he said. “It’s indicative of sloppy billing practices for sure, but it’s not egregious.”

Of equal concern, he said, were findings that drug prescriptions were being changed by unauthorized staff.

“That’s a quality-of-care issue,” Porter said. “You can’t have a receptionist handing out pills.”

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Two comments on this story so far. Add yours!

• 

  socialismSux on August 13 at 12:51 a.m.

  This is fraud.

  Shut them down.

  Federal crime. CRIME, not merely civil penalties. Send them to jail!

  Flag as inappropriate

• 

  moredug on August 15 at 11:28 a.m.

  As someone who has worked in the healthcare compliance industry full time for the last 8 years; attempting to decipher all the documentation, billing (including bundling of services), medical necessity for visits, all of which are different for the individual payer involved (i.e.Medicaid, Medicare, private health care payers, self pay), I would be hard pressed to call this fraud. The Medicare program defines fraud as purposely billing Medicare for services that were never provided or received. Other payers’ definitions of fraud are extremely comparable. The Medicare program readily admits that most payment errors are simple mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. It appears Planned Parenthood of Spokane, does not have individuals coding, billing or providing oversight of these administrative billing functions who are adequately educated of the various different rules and regulations.. The redulatons are extremely complex and require constant attentiveness as they can change on a daily bases. PP of Spokane needs to develop a comprehensive compliance plan which includes staff education to make sure they are billing for services appropriately, to prevent future billing mistakes.

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