DR. MALLOY: The patient in – while she’s in my office for services - -
SHIRLEY BENSON: Uh-huh?
DR. MALLOY: - - determines whether she is pregnant. Is that correct?
SHIRLEY BENSON: [No audible response]
DR. MALLOY: Based on everything that you’ve heard today.
SHIRLEY BENSON: Okay. In this case, based on the documentation I reviewed, based on everything done, majority of these women knew they were pregnant when they came into your office. Yes, sir.
DR. MALLOY: Okay, that’s – okay, now that’s
speculation. Are you saying that these patients knew? How? Based on - -
SHIRLEY BENSON: And you did the pregnancy test to confirm it.
DR. MALLOY: No, no, no, no. I’d just like to know how do you know, based on everything that you’ve been able to review, that these patients knew they were pregnant?
SHIRLEY BENSON: Most of them came in with a, uh, missed periods, amenorrhea basically being another diagnosis for missed periods.
DR. MALLOY: Okay, but you’re saying that they knew. Okay. I’m just saying, I – I want to know how do you know that they knew that they were pregnant?
SHIRLEY BENSON: I would review some of the documentation, but it will show you.
DR. MALLOY: Okay. I – I, Ms. Benson?
SHIRLEY BENSON: Yes, sir?
DR. MALLOY: I – I will concede that a woman who has a missed period will – will assume that she may be pregnant. I will concede that.
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: You have that. But, as a Medicaid-eligible recipient, it’s covered under family planning, it’s covered under obstetrical services,
it’s covered under GYN services - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - that she can visit a Medicaid provider - -
SHIRLEY BENSON: That’s true.
DR. MALLOY: - - to obtain the information related to why she hasn’t had a period. Is that correct?
SHIRLEY BENSON: That’s correct.
DR. MALLOY: Okay. So she has done nothing wrong at that time. Is that correct?
SHIRLEY BENSON: [No audible response]
DR. MALLOY: By coming in to find out if she’s pregnant and how far along she is. She’s the patient; the recipient has done nothing wrong?
SHIRLEY BENSON: Okay.
DR. MALLOY: The clinician has done nothing wrong, or has he or she done anything wrong, if they order lab tests to determine if the person is pregnant and how far along they are? Just at that point, has the clinician done anything wrong?
SHIRLEY BENSON: No.
DR. MALLOY: Okay. At that point – correct me if I’m – if – if – correct me if I’m wrong – the patient,
at that point, now knows or should know, okay - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - whether or not she’s pregnant and how far along she is.
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: For the most part - -
SHIRLEY BENSON: Yes.
DR. MALLOY: - - that’s correct. Now, at that point, the patient – from your records that you reviewed – can make a decision on how she handles that pregnancy? From the records that you reviewed.
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: Is that correct?
SHIRLEY BENSON: Yes.
DR. MALLOY: Okay. So if she elects to terminate the pregnancy, for whatever reason - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - what you’re saying is that any laboratory data that was done for confirmation of pregnancy, even though she’s eligible to receive that, is considered a misrepresentation or fraudulent activity on the part of the clinician or the provider if – if they bill for those services? Is that what you’re saying?
SHIRLEY BENSON: Correct. What I’m saying is the
patient has presented herself to your office to
determine whether pregnancy was negative or positive. If that day she decides that it’s positive, she decides she wants an abortion. At that time, your billing process and procedures should change. That patient becomes a private pay at that moment because Medicaid does not pay for abortion, abortion-related services. So that patient becomes a private pay. So, therefore, the services she had from the time she walked in your door ‘til the time she left is as a private pay, not as a Medicaid member.
DR. MALLOY: Okay. But when she walks in the door - -
SHIRLEY BENSON: Right.
DR. MALLOY: - - and she is coming in to find out if, indeed, she is pregnant and how far along she is - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - at that point, am I correct in stating that she is eligible for not only that care, but I’m eligible to be reimbursed for those services?
SHIRLEY BENSON: As I previously stated, when she came in, you was – you took – you accepted her as a Medicaid member, which is correct. But when she made that decision to proceed to the next step as being abortion that day, she’s no longer a Medicaid member eligible for services that are – these services are not covered by the Department. So, therefore, all services occurred that day, as I stated, she is to be treated as a private pay.
DR. MALLOY: Okay. And I’m – I’m – I’m gonna move on [indistinct] something else, but, okay, so you’re saying that – and I, because I – I have never seen that in any of the physician manuals, so you’re saying that her eligibility actually changes even though the service that she came in for - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - the service she came in for was pregnancy confirmation - -
TARA DICKERSON: I’m gonna object to that again, Your Honor.
DR. MALLOY: Okay. She came - -
JUDGE TEATE: Sustained.
DR. MALLOY: She came in to determine – she came – she came in to the GYN office for either missed period, abnormal period; you even said that yourself.
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: Okay? And so I provide the services to determine why she missed her period and, if she’s pregnant, how far along she is.
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: That’s what she came in for and that is, if I’m correct, that’s what she came in for; and you say that if it had stopped there, those services she’s eligible for and I’m eligible for reimbursement?
SHIRLEY BENSON: Because those are covered services.
DR. MALLOY: Okay. Ms. Benson, you’ve been in Program Integrity for approximately five years.
SHIRLEY BENSON: No, I’ve been in Program Integrity for 20 - -
DR. MALLOY: I’m sorry. You said since 2005.
SHIRLEY BENSON: No, I was a Director since 2005.
DR. MALLOY: I apologize. I apologize. Ms. Benson, are you aware that emergency rooms, community health centers, health departments perform tests similar to what was done in my office for patients who come in with missed periods and abnormal periods?
SHIRLEY BENSON: Yes.
DR. MALLOY: Okay. And are you aware – and are you aware that those same facilities may [indistinct] are you aware that those facilities may or may not have any idea what that patient is going to do with that pregnancy?
SHIRLEY BENSON: That’s correct. I agree with
you.
DR. MALLOY: Okay. So if DeKalb Medical Center emergency room sees a patient for amenorrhea or missed period - -
SHIRLEY BENSON: Uh-huh?
DR. MALLOY: - - and DeKalb Medical Center emergency room determines that the patient is pregnant and the patient asks DeKalb Medical Center, I want to terminate this pregnancy; can you refer me to a facility? And DeKalb Medical Center says, We have doctors here that can do it right here in the hospital, and a doctor does it, so are you saying – and does it that day, that day - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - so is DeKalb Medical Center not able to get reimbursed for seeing that patient in the emergency room?
SHIRLEY BENSON: Not if – no, they can see the patient in the emergency room.
DR. MALLOY: I beg your pardon? [Indistinct; overlapping conversation]
SHIRLEY BENSON: But you don’t find patients going to emergency room. It will ‘cause – because [indistinct] non-emergency visit. I understand what you’re trying to say. But, um, the situa – that would
not occur that way. Okay?
DR. MALLOY: [Overlapping conversation]
SHIRLEY BENSON: It could be in a clinic or whatever. If a possibility that it did occur and [indistinct] it wouldn’t be emergency visit. If it was a clinic visit. If we found out a combination of one led to the other, when we find it, yes, it will be recoupable.
DR. MALLOY: Okay. So [indistinct] so correct me if I’m wrong – so health departments, community health centers, emergency rooms, every private practice in Atlanta has been informed – correct me if I’m wrong – that if they obtain information to date a pregnancy and the patient decides to terminate that pregnancy, that there is something that states that they will not be reimbursed if that patient has a termination even though they’ve billed Medicaid for services related to missed period, abnormal bleeding in their office or community health center?
SHIRLEY BENSON: The abortion policy is in the hospital policy.
DR. MALLOY: I’m – I’m sorry?
SHIRLEY BENSON: The abortion policy is in the hospital policy.
DR. MALLOY: Okay.
SHIRLEY BENSON: Most of the – like your clinics,
your health department, all of them, basically, the facilities do not – they do not bill us for abortions.
DR. MALLOY: Okay.
SHIRLEY BENSON: Or abortion-related services [overlapping conversation].
DR. MALLOY: And you’re absolutely right. I – I agree with you. But you’re also saying that they would not bill you for services, such as an ultrasound, hematocrit, pregnancy test.
SHIRLEY BENSON: No. The health department performs those tests, yes, but they do not do abortions.
DR. MALLOY: Okay. But would your Department reimburse the health department for those tests?
SHIRLEY BENSON: Yes.
DR. MALLOY: And if the health department knew that they were sending the patient across the street to have an abortion that day, would they be reimbursed for those tests?
SHIRLEY BENSON: I cannot speak to that point because I don’t see them doing that. I don’t know.
DR. MALLOY: Okay. Ms. Benson, um, I – I – I venture to say I – do you have any idea of the number of GYN practices there are in Atlanta? Just a guess.
SHIRLEY BENSON: No, I don’t.
DR. MALLOY: Okay. Do you have any idea of the number of GYN private practices where physicians might do terminations in their office?
SHIRLEY BENSON: No, I don’t [indistinct].
DR. MALLOY: Um, are you aware of Planned Parenthoods in the state of Georgia?
SHIRLEY BENSON: Yes.
DR. MALLOY: Are you aware that Planned Parenthoods, some of them in the state of Georgia, perform abortions?
SHIRLEY BENSON: No, [overlapping conversation].
DR. MALLOY: If you’re not – if you’re not, just say you’re not aware.
SHIRLEY BENSON: No.
DR. MALLOY: Okay. And [sighing] if Planned Parenthoods’ offices who perform abortions billed Medicaid for procedures – ultrasound, hematocrit, pregnancy test – would they be reimbursed?
SHIRLEY BENSON: Yes.
DR. MALLOY: They would be reimbursed? But because I do it – I bill for a pregnancy test, ultrasound, urinalysis – and I or one of my colleagues performs an abortion after the patient has determined that, then I am not to be reimbursed because I should have bundled them together and sent a D – DMA
[indistinct]?
SHIRLEY BENSON: No. You still [overlapping conversation].
DR. MALLOY: If – if it fell – if it fell into the three reasons why. Every time I say – I’m – I’m always thinking about falling into the reason. I’m not just saying send this end for an abortion; unless a patient is raped, incest or endangerment of life of the mother.
SHIRLEY BENSON: That is policy.
DR. MALLOY: Okay. Okay. [Sighing] Okay. [Indistinct]
JUDGE TEATE: Anything on redirect?
TARA DICKERSON: Yes, Your Honor, I do want to redirect.
JUDGE TEATE: Okay.
TARA DICKERSON: If you look at Exhibit DD?
The first page, Patient Information on Leaving. Do you see that?
SHIRLEY BENSON: Yes.
DR. MALLOY: [Indistinct] do I have that?
TARA DICKERSON: Yes, you do, DD. It’ll be in your – -it’ll be in your first – - it’ll be in here. [Indistinct]
DR. MALLOY: Okay.
TARA DICKERSON: You see that [indistinct] FF [pages shuffling; indistinct].
DR. MALLOY: Oh, [indistinct]. I’m sorry.
TARA DICKERSON: DD.
DR. MALLOY: Okay.
TARA DICKERSON: What’s the purpose of the visit?
SHIRLEY BENSON: Purpose of the visit is termination.
TARA DICKERSON: Is this a Medicaid member? SHIRLEY BENSON: [No audible response]
TARA DICKERSON: Go to the next page.
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Okay. Go to EE, please. EE’ll be right after DD. You see that first page? They’ll be a separator.
SHIRLEY BENSON: Okay.
TARA DICKERSON: What’s the purpose of the visit?
SHIRLEY BENSON: Abortion.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Go to FF. What’s the purpose of the visit?
SHIRLEY BENSON: Abortion.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Go to GG, please. What’s the purpose of the visit?
SHIRLEY BENSON: Abortion.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: This one doesn’t say.
TARA DICKERSON: Could you go to the third page?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Go to HH, please. What’s the purpose of the visit?
SHIRLEY BENSON: Termination.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Go to II, please.
SHIRLEY BENSON: Terminate pregnancy.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: Go to JJ, please.
SHIRLEY BENSON: Purpose of the visit, terminate – um, abortion.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes.
TARA DICKERSON: Next record, please. What’s the purpose of the visit?
SHIRLEY BENSON: Abortion.
TARA DICKERSON: Is this a Medicaid member?
SHIRLEY BENSON: Yes, it is.
TARA DICKERSON: With regard to the records that you have before you, the purpose of the visit was an abortion, correct?
SHIRLEY BENSON: Correct.
TARA DICKERSON: The purpose of the visit, did you at any time see an indication that I’m trying to determine how – what stage of pregnancy I’m in?
SHIRLEY BENSON: No.
TARA DICKERSON: How many weeks I’m pregnant?
SHIRLEY BENSON: No.
TARA DICKERSON: Is it a male or a female?
SHIRLEY BENSON: No.
TARA DICKERSON: Did you see anything indicating anything other than the purpose of the visit was an abortion?
SHIRLEY BENSON: Nothing.
TARA DICKERSON: Your Honor, we would ask the Court [indistinct] review all these records, it will reflect with regard to the Medicaid patients the purpose of the visit was an abortion.
JUDGE TEATE: [Indistinct]
TARA DICKERSON: So when the person showed up, they wanted an abortion, correct?
SHIRLEY BENSON: Correct. That was their reason
for coming to the office.
TARA DICKERSON: No other questions.
JUDGE TEATE: Re-cross?
DR. MALLOY: Yes. Ms. Benson?
SHIRLEY BENSON: Yes?
DR. MALLOY: Um, Attorney Dickerson just asked you – she read – read all the [indistinct] number of patients where the form stated purpose of the visit was for an abortion.
SHIRLEY BENSON: Correct.
DR. MALLOY: Okay. Um, now, because it states that the purpose of a visit was for an abortion, are you going to sit there now and say that every patient who has that written is going to have an abortion?
SHIRLEY BENSON: The purpose of the visit, I’m just – I can’t do anything but assume the reason they came was to terminate pregnancy or for abortion.
DR. MALLOY: Okay. And are you familiar with the Women’s Right to Know Act in the State of Georgia?
SHIRLEY BENSON: Not that much.
DR. MALLOY: Okay. Um, suffice it to say - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - that the Women’s Right to Know Act - -
SHIRLEY BENSON: Uh-huh?
DR. MALLOY: - - states that a patient has to be aware that in order to have an abortion, she has to let us know that within 24 hours of coming into the office. So that’s just – are – are you – will you take that as a summation of the Women’s Right to Know?
JUDGE TEATE: Sir, I think we’re talking [indistinct] here just on re-cross - -
DR. MALLOY: Okay.
JUDGE TEATE: - - and all that’s been introduced on re – on redirect is just referenced to the – your sheets with the information. So - -
DR. MALLOY: Oh, okay. Sorry. Um, on – on those – oh, you have – you have the records there. Um, you can – you can take any – any one of those, the patients, the Medicaid patients that she mentioned - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - any of them, LL, KK, doesn’t matter – and go to the Pregnancy Verification page.
The Pregnancy Verification Form on any of them because it all [indistinct].
SHIRLEY BENSON: Uh-huh?
DR. MALLOY: Um, and – and, if you could read the first – the first paragraph, please?
SHIRLEY BENSON: The above-named patient
presented herself at Old National GYN with a diagnosis
of amenorrhea. She is - -
DR. MALLOY: Okay. You can – you can stop there. So is it the physician, as far as you know, or the patient who makes a diagnosis?
SHIRLEY BENSON: The physician.
DR. MALLOY: Okay. So, on that form, is a form generated from my office that states the patient is there for amenorrhea?
SHIRLEY BENSON: The form does.
DR. MALLOY: The form [indistinct], yes.
SHIRLEY BENSON: [Indistinct]
DR. MALLOY: Now, her diag – she, on – on the page that – that Attorney Dickerson was – the Patient Information Form, the patient has written she’s there for an abortion, but our medical records indicate that the reason she is there is for amenorrhea. And that’s what’s on the Pregnancy Verification Form, something that we have in the chart, and every one of those charts that you went through, from BB to LL, do - -
SHIRLEY BENSON: Yes.
DR. MALLOY: - - would you agree?
SHIRLEY BENSON: Yes.
DR. MALLOY: That’s what – okay. So you agree and I’m – this is [indistinct] that the patient is putting she’s coming in for an abortion, but the records state the reason that she is in the office that is generated by the clinician or the provider is for amenorrhea? I’m just asking - -
SHIRLEY BENSON: Uh - -
DR. MALLOY: - - is that what that says?
SHIRLEY BENSON: Okay.
DR. MALLOY: Well, yes or no?
SHIRLEY BENSON: A preprinted form with a diagnosis of amenorrhea is not telling me that that’s why she actually there. Her chief complaint comes into the office tells me she is terminating pregnancy. How did you find out about it? It was either referred by another physician or they find you in the Yellow Pages.
DR. MALLOY: Okay, [overlapping conversation].
SHIRLEY BENSON: And the reason they want to was to terminate their pregnancy.
DR. MALLOY: [Indistinct]
SHIRLEY BENSON: To cover your office basically, which I knew all offices do, will have to do a pregnancy test to determine if she is actually pregnant before you decide to proceed with the procedure. So that’s what this is and that is what was done.
DR. MALLOY: Okay. Ms. Benson, you made a
statement. You stated that the patient’s chief complaint - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - is to - -
SHIRLEY BENSON: Uh, the reason they’re in, was it a purpose of the visit.
DR. MALLOY: Okay. Okay. Because that’s, purpose of a visit – correct me if I’m wrong - -
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: - - purpose of a visit and chief complaint are two - -
SHIRLEY BENSON: Yes.
DR. MALLOY: - - separate - -
SHIRLEY BENSON: I agree. So - -
DR. MALLOY: - - issues?
SHIRLEY BENSON: I’m standing correcting myself - -
DR. MALLOY: Okay.
SHIRLEY BENSON: - - by stating the purpose of the visit.
DR. MALLOY: Okay. Okay. So let’s make sure [indistinct].
SHIRLEY BENSON: Yes.
DR. MALLOY: The purpose of the visit has been
noted to be abortion.
SHIRLEY BENSON: Yes.
DR. MALLOY: That says – there’s nothing on that form that says chief complaint - -
SHIRLEY BENSON: That’s correct.
DR. MALLOY: - - about anything?
SHIRLEY BENSON: That’s correct.
DR. MALLOY: The only place where you see any information that would be related to a chief complaint, okay, which is what we, the clinicians, determine, is on that Pregnancy Verification Form? If you see if someplace else, let me know.
SHIRLEY BENSON: Uh-uh, don’t see it.
DR. MALLOY: Because you – you said chief complaint and the - -
SHIRLEY BENSON: [Indistinct]
DR. MALLOY: - - Pregnancy Verification Form is what we generate out of our office. It’s a form that I put together, as the clinician, and my diag – my diagnosis when the patient comes in, okay, is what you saw on that first – correct me if I’m wrong – is what was written in the first sentence of that page?
SHIRLEY BENSON: Uh-huh.
DR. MALLOY: Okay. I just wanted to make sure that I’m not putting words in – into your mouth?
SHIRLEY BENSON: No.
