OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION STUART \V. BOWEN JR. INSPECTOR GENERAL October 19,2015 **** NOTICE OF TERMINATION **** Via First Class Mail & CMRRR No. 7015 1730 0000 9897 1876 Planned Parenthood Gulf Coast Registered Agent: Melaney Linton 4600 Gulf Freeway Houston, Texas 77023-354 Re: Planned Parenthood Gulf Coast TPII’Jumbers: 0834095-01, 1126104-08, 1126104-09. 3035461-01, 1126104-05, 1126104-04, 1126104-12, 1126104-14, 112610411, 1126104-10, 1126104-06,083409502, 1126104-02, 1126104-07 Dear Provider: Your receipt of this Notice of Termination effects a process to end your enrollment in the Texas Medicaid program. See I TEX. ADMIN. CODE § 37 1.1703(e) (2014). We have begun terminating your enrollment because, based on the evidence outlined below, you are Liable, directly or by affiliation, for a series of serious Medicaid program violations. The State has determined that you and your Planned Parenthood affiliates are no longer capable of performing medical services in a professionally competent, safe, legal, and ethical manner. Your termination and that of all your affiliates will not affect access to care in this State because there are thousands of alternate providers in Texas, including federally qualified health centers, Medicaid-certified rural health clinics, and other health care providers across the State that participate in the Texas Women’s Health Program and Medicaid. Our women’s health programs, mostly State-funded since 2013, have increased overall funding for women’s health services and access to these services for women across the State. Therefore, in connection with this Notice of Termination and out of respect for the patients who otherwise would receive Medicaid services from you and your affiliates, the State of Texas P.O. Box 85200, Auslin, Texas 78708• (512) 491-2000 Notice of Termination October 19, 2015 Page 2 requests your cooperation in informing all clients and potential clients about alternatives where they can obtain Medicaid services from providers in good standing with the State. HHSC staff will provide you with information you can share regarding those Medicaid providers. I. FINDINGS SUPPORTING TERMINATION We have determined the bases for your termination are as follows: A. Earlier this year, you committed and condoned numerous acts of misconduct captured on video that reveal repeated program violations and breach the minimum standards of care required of a Medicaid enrollee. You are being terminated from the program because of these program violations, which include, but are not limited to, the following: I. The videos indicate that you follow a policy of agreeing to procure fetal tissue even if it means altering the timing or method of an abortion. These practices violate accepted medical standards, as reflected in federal law, and are Medicaid program violations that justify tennination. See 42 U.S.C. § 289g-l; I Thx. ADMIN. CODE § 37 1.1659(2) and (6). 2. You failed to prevent conditions that would allow the spread of infectious diseases among employees, as well as patients and the general public. Specifically, you allowed individuals posing as commercial buyers of fetal body parts to handle bloody fetal tissue while wearing only gloves. You did not comply with mandatory “universal precautions,” including the use of “protective barriers,” required whenever anyone handles “blood,” “nonintact skin,” and “body fluids.” See 25 TEx. ADMIN. CODE § 139.49; see also 29 CFR § 19 10.1030. These program violations justify termination. See 1 TEx. ADMIN. CODE § 371.1659(2) and (6). 3. Your staff were not trained in infection control and barrier precautions with regard to the handling of fetal blood and tissue or they failed to comply with the minimum standards that mandatory training requires with regard to these critical public health and safety issues. See 25 TEX. ADMIN. CODE § 139.49(b)(3). These program violations justify termination. See 1 Thx. ADMLN. CODE § 371.1659(2) and (6). As a Planned Parenthood affiliate, you have agreed to abide by mandatory medical and operational standards established by the Planned Parenthood Federation of America (PPFA) located in Washington, D.C. You are a legal affiliate of the PPFA and of all similarly situated Planned Parenthood providers in Texas. Our decision to terminate you and all affiliates in Texas finds support in the extensive video evidence filmed at your facility and other Planned Parenthood affiliates across the country, including video footage of the Medical Director of Notice of Termination October 19, 2015 Page 3 PPFA who appears to not only condone such program violations but also endorse them. This suggests that the program violations recorded at your facility reflect PPFA national policy or accepted practice, which explains in part their widespread occurrence across the country among Planned Parenthood affiliates. B. My office has information suggesting that fraud and other related program violations have been committed by a number of Planned Parenthood affiliates enrolled in the Medicaid program in Texas, including you. For example, there is reliable information indicating a pattern of illegal billing practices by Planned Parenthood affiliates, including you, across the State. Our prima facie case of fraud is supported by related cases involving fraudulent practices identified by Whistleblowers from inside the Texas Planned Parenthood network. These Whistleblowers alleged in federal court that Planned Parenthood encourages employees to knowingly file false claims. See, e.g, Settlement Agreement, Reynolds i’. Planned Parenthood Gulf Coast, No. 9:09-cv-l24 (ED. Tex. July 25, 2013) (lawsuit by a health care assistant who worked at Planned Parenthood Gulf Coast for 10 years alleging Medicaid fraud); Memorandum Opinion and Order, C’arroll v. Planned Parenthood Gulf Coast, 4:12-cv-03505 (S.D. Tex. May 14, 2014) (lawsuit by a former accountsreceivable manager at Planned Parenthood Gulf Coast alleging Medicaid fraud). In Reynolds, a Planned Parenthood Whistleblower alleged sufficient evidence of fraud to assure the federal court handling the matter that the case was worth pursuing, after which Planned Parenthood promptly settled the lawsuit for $4.3 million. Furthermore, when the United States Department of Justice (DOJ) announced the 2013 settlement in Reynolds, it openly and compellingly criticized PPGC for “abuse of programs that are extremely important to the well-being of many American women.” Further, the DOJ was “particularly grateful to the Whistleblower” who came forward for revealing that Planned Parenthood Gulf Coast had billed the Texas Medicaid program, Title XX, and the Women’s Health Program “for items and services that were either medicalLy unnecessary or were never actually provided.” The varied program violations by Planned Parenthood revealed in these two federal cases and the information my office has recently received regarding similar program violations supports this Notice of Termination. See I Tex. Admin. Code § 371.1653. Our rules provide that if you are affiliated with a provider that commits program violations subjecting it to enrollment termination, then you, as an affiliate, are subject to the same enrollment termination. See 1 TEx. ADMIN. CODE § 37l.l703(c)(7). The definitions section of our rule substantiates this position. It provides that an enrolled provider is an affiliate of another enrolled provider if it Notice of Termination October 19, 2015 Page 4 “shares any identifying information, including corporate or franchise name.” You share such identifying information with other affiliates about which a prima facie case of fraud exists and are thus subject to termination. See I TEX. ADMIN. CODE § 371.1607(3)(I). Your affiliation with Planned Parenthood entities in Texas about which there is reliable evidence of fraud and other program violations as well as your participation in such substantiates your termination as an enrollee in the Medicaid program. See 1 TEx. ADMIN. CODE § 371.1703(c)(6), (c)(7). and (c)(8). ... - II. PROCESS You may request an Informal Resolution Meeting (WrvI) with my legal staff to discuss the findings in this Notice of Termination. If you wish to pursue an IRM, you must file a written request with my office on or before the 30 calendar day from the date you received this Notice of Termination. Your request for an IRM must: 1. Be sent by certified mail to my office at the address specified below; 2. Include a statement as to the specific issues, findings, and legal authority in the Notice of Termination with which you disagree; and 3. Be signed by you or your attorney. In the alternative, you may submit, within 30 calendar days of receipt of this Notice, any documentary evidence and written argument regarding whether this Notice of Termination is warranted. See I TEX. ADMIN. CODE § 371.1613 (d). You must state the specific issues, findings, and legal authority that support your contention that this Notice is improper. In the further alternative, you may both request an ILM and submit documentary evidence and written argument to contest this Notice of Termination. III. FINAL TERMINATION If you fail to respond to this Notice of Termination within 30 calendar days of recejp, then we will issue a Final Notice of Termination. Alternatively, if the IRM fails to resolve the case, then we will similarly issue a Final Notice of Termination. You have 15 days after receipt of the Final Notice of Termination to request an administrative hearing to appeal the Final Notice before an Administrative Law Judge at the Texas Health and Human Services Commission. A. The effective date of your final termination from the Medicaid program will be either: 1. Upon the expiration of 15 calendar days after receipt of the Final Notice of Termination, if you do not timely request an administrative hearing before HHSC; or Notice of Termination October 19, 2015 Page 5 2. The date of any final order issued by an HHSC Administrative Law Judge affirming the Final Notice of Termination. B. Once the Final Notice of Termination becomes effective, the following events immediately occur: 1. Your enrollment in the Medicaid program terminates; 2. Your Texas Provider Identification Number is revoked; and 3. Your enrollment in the Medicaid program of any other state may be subject to revocation. It after your termination from the Texas Medicaid program, you wish to enter the program again, you must apply for re-enrollment, NOTICE IF YOU DO NOT RESPOND TO THIS NOTICE WITHIN 30 CALENDAR DAYS FROM THE DATE YOU RECEIVED IT, WE WILL ISSUE A FINAL NOTICE OF TERMINATION. Requests for an IRM and/or the provision of additional documentary evidence and written argument should be mailed via certified mail to the following address: Texas Health and Human Services Commission Office of Inspector General Mail Code 1358 P.O. 85200 Austin, Texas 78708-5200 Respectfiflly yours,