Planned Parenthood Fraud Claims Revived
(CN) - Planned Parenthood must face claims from a former manager in Iowa that it fraudulently billed Medicare for abortion services, the 8th Circuit ruled.
Susan Thayer worked as the center manager of Planned Parenthood's Storm Lake, Iowa, clinic from 1991 to 2008. She claims she was fired when she expressed opposition to the prescription of abortion drugs without an in-person meeting with a doctor.
Turning whistle-blower in 2011, Thayer accused the Iowa-based nonprofit of submitting fraudulent claims for Medicare reimbursement. Thayer is represented by the Alliance Defending Freedom.
Some of the fraudulent billing allegedly included filing claims for unnecessary quantities of birth control pills prescribed without examinations, seeking reimbursement for abortion-related services by lying about the cause of abortion complications, and filing full claims for services when part of the bill had already been paid by a patient's coerced "donation."
Thayer gave no representative example of one of these alleged false claims, however, prompting Planned Parenthood to that the complaint must be dismissed for failure to plead particularity.
A federal judge in Des Moines found for Planned Parenthood, but the 8th Circuit revived most of Thayer's claims Friday.
"Thayer adequately alleges the particular details of these schemes, such as the names of the individuals that instructed her to carry out these schemes, the two-year time period in which these schemes took place, the clinics that participated in these schemes, and the methods by which these schemes were perpetrated," Judge Roger Wollman wrote for a three-judge panel. "Moreover, she alleges that her position as center manager gave her access to Planned Parenthood's centralized billing system, pleads specific details about Planned Parenthood's billing systems and practices, and alleges that she had personal knowledge of Planned Parenthood's submission of false claims."
The St. Louis, Mo.-based court did, however, affirm dismissal of Thayer's "upcoding" allegations, which assert only that Planned Parenthood would use a "problem code" for services provided "even though the physician would usually only briefly look into the room from the hallway at the client or not even see the client."
"Thayer failed to allege when or how often upcoding took place at the various clinics, who or how many physicians engaged in upcoding, or what types of services were involved in the upcoding scheme," Wollman said.
Planned Parenthood told the Des Moines Register there is "no merit" to Thayer's suit.
"The 8th Circuit Court of Appeals dismissed completely two of her claims and referred the remaining claims back to the district court to consider Planned Parenthood's defenses that its actions were at all times consistent with applicable state and federal regulations," the nonprofit reportedly said. "The Court of Appeals reversed the District Court's dismissal of those remaining claims on narrow legal grounds, without addressing whether those claims have merit."