AUGUSTA — Maine Family Planning has asked a judge to overturn a Department of Health and Human Services order seeking repayment of $184,000 that the state says it overpaid the nonprofit for reproductive health care services provided to women on the same days they had abortions.
The charges were for Depo-Provera – a birth control injection – and for services that lacked documentation.
The appeal, filed in Kennebec County Superior Court, says that before the LePage administration took office, the DHHS “consistently interpreted MaineCare rules to cover reimbursement for clinically necessary reproductive healthcare services provided to pregnant women regardless whether those women subsequently had abortions.”
DHHS spokesman David Sorensen said Wednesday that the department did an audit that revealed Maine Family Planning “had been improperly billing Maine’s taxpayer-funded Medicaid program for abortion-related services in violation of Medicaid law.” Sorensen said it was “a clear violation” for the association to bill “taxpayers for abortion-related services provided on the same day as abortions.”
“The department has taken appropriate action to enforce the law, treating Maine Family Planning’s case as it would any other audit of a MaineCare provider,” Sorensen said.
Kathleen Brogan, vice president for public affairs at Maine Family Planning, on Wednesday called the matter “an internal Medicaid billing dispute.” The total amount sought by DHHS is $184,620.
“We got some direction from the department more than 10 years ago for what services would be reimbursable, and they said we were not allowed to bill them that way anymore,” Brogan said. “They just changed their interpretation of what was appropriate and never let us know. We think it’s very interesting that we billed that way through two administrations, and very soon after the current administration took over, it became unacceptable.”
Brogan also said the association quit billing for those services as soon as it became an issue.
The court appeal alleges that before any findings were reached in the audit of MaineCare billing, DHHS “asserted to Republican legislators with anti-abortion views” that Maine Family Planning had committed fraud.
The nonprofit has been working with the state department to try to resolve the dispute, Brogan said. If its decision stands, the agency will pay and “it will be a burden, but it’s not going to stop us from providing services.”
In a news release Wednesday, DHHS Commissioner Mary Mayhew said audits of Medicaid providers “are a key component of that work and required under the federal Medicaid program.”
“Federal law prohibits taxpayer-funded Medicaid reimbursements for abortion services, with limited exceptions,” Mayhew said in the release. “Maine Medicaid regulations prohibit reimbursement for any services ancillary to a non-covered service. The audit of Maine Family Planning found that they had billed Medicaid for ancillary services, including abortion-related services provided on the same day as an abortion.”
Documents included with the appeal show that a notice of violation was sent to Maine Family Planning on June 24, 2011.
The court appeal quotes sections of the MaineCare benefits manual that say “MaineCare covers abortions ‘only if necessary to save the life of the mother, or if the pregnancy is the result of an act of rape or incest.’ ” In a message distributed widely to medical care providers, DHHS also said, “If the abortion will not be covered by MaineCare, then any related services both prior to and following the abortion are also not covered. This includes blood tests, ultrasounds, or other tests. Before the procedure, the provider needs to tell the member that she will be sent a bill for the services.”
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