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Maine Clinic Appeals $184K Repayment Order from State Dept. of Health and Human Services

October 9, 2015 — A Maine reproductive health and abortion provider has appealed to overturn a state order that the clinic repay $184,620 in allegedly improper Medicaid billings, the Kennebec Journal/Portland Press Herald reports.

Background

David Sorensen, a spokesperson for the state's Department of Health and Human Services, said DHHS conducted an audit of Maine Family Planning, which found that the clinic violated Medicaid law by billing the state Medicaid program "for abortion-related services provided on the same day as abortions."

According to DHHS Commissioner Mary Mayhew, Medicaid does not reimburse for abortion services except in limited circumstances, and Maine's Medicaid program "prohibit[s] reimbursement for any services ancillary to a non-covered service." In a message to providers, DHHS noted that services related to an abortion that is not covered by the state's Medicaid program -- including "blood tests, ultrasounds, or other tests" -- are not covered, and that providers must inform patients they will be billed for such services.

According to the Kennebec Journal/Portland Press Herald, the contested charges were for the contraceptive injection Depo-Provera and for other undocumented services that were provided on the same day as an abortion.

Details of the Appeal

Maine Family Planning appealed the allegations in Kennebec County Superior Court. According to the appeal, DHHS before Gov. Paul LePage (R) took office "consistently interpreted MaineCare rules to cover reimbursement for clinically necessary reproductive healthcare services provided to pregnant women regardless whether those women subsequently had abortions."

The appeal also states that DHHS "asserted to ... legislators with anti-abortion views" that the clinic committed fraud before the investigation made any findings.

Comments

Kathleen Brogan -- vice president for public affairs at Maine Family Planning -- on Wednesday said, "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."

She continued, "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 noted that if the decision stands, Maine Family Planning will fulfill the repayment order. She said payment would "be a burden, but it's not going to stop us from providing services" (Adams, Kennebec Journal/Portland Press Herald, 10/7).