Investigation launched into Planned Parenthood's coding practices for hormone…
- Reports
- 4
- Developments
- 1
- Repetition
- 75%
New informationRepeats or wire copies
What happened
Do No Harm, a nonprofit organization, asked the Department of Health & Human Services inspector general to investigate Planned Parenthood regarding alleged miscoding of youth cross-sex hormone prescriptions. The group claims that Planned Parenthood and its affiliates may be coding visits in a way that makes these hormone prescriptions appear routine. This alleged miscoding could allow private and public insurers to cover treatments that might otherwise be excluded because government insurers like Medicare and Tricare only reimburse for medically necessary treatments.
From ewtnnews.com
Why it matters
The investigation challenges the reimbursement integrity of government-sponsored health programs. The allegations suggest that Planned Parenthood may be seeking payment for procedures by obscuring their nature, which could impact how Tricare and Medicare process payments for specific treatments.
From ewtnnews.com
Who's involved
- Planned ParenthoodOrganization under investigation for alleged miscoding of youth hormone prescriptions.
- TricareHealth care program whose reimbursement rules are cited in the allegations.
- MedicareUS federal health insurance program whose reimbursement rules are cited in the allegations.
- Department of Health & Human ServicesGovernment agency asked to investigate the alleged fraudulent billing practices.
Who could feel it
Possible knock-on effectsThese are possibilities Brind reasoned out, not predictions, and not advice. Most are not stated in any report.
- Planned ParenthoodSpeculative
Planned Parenthood might face reduced revenue or funding if the investigation confirms improper coding practices.
- TricareSpeculative
Tricare could face increased compliance costs or changes to its reimbursement integrity if coding practices are found to be non-compliant.
- MedicareSpeculative
Medicare could face increased compliance costs or changes to its reimbursement integrity if coding practices are found to be non-compliant.
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The entities involved
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Planned Parenthood
organization that provides reproductive health services in the United States and internationally
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Tricare
health care program of the United States Department of Defense Military Health System
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Medicare
US federal health insurance