Adoption agencies probed over suspected double-billing

Cases in Hawaii involve Marshallese birth mothers

December 12, 2003|By Walter F. Roche Jr. | Walter F. Roche Jr.,SUN NATIONAL STAFF

The Hawaii attorney general's office has launched an investigation to determine whether adoptive parents and Medicaid were double-billed for the hospital costs of women flown to the state from the Marshall Islands to give birth and then relinquish their newborn children.

Christopher Young, the lawyer who directs the attorney general's Medicaid fraud unit, acknowledged that an investigation focusing on the billing practices of the agencies arranging the adoptions had begun.

He said subpoenas had been issued to obtain records of adoptions involving recently arrived Marshallese women but declined to discuss details.

The investigation began after a two-part Sun series last month that described how pregnant women were being flown from the Pacific island nation to Hawaii and Oklahoma by two agencies and a lawyer.

Under a Compact of Free Association governing ties with the United States, Marshall Islands citizens can enter the United States without visas. Children born to Marshallese while they are in the United States automatically become U.S. citizens.

A sworn and notarized affidavit in a Hawaii adoption arranged by one of the agencies, Adoption Choices, and signed by the adoptive parents this year states that they paid the agency $2,500 for "hospital bill for birth mother" and $1,400 for a "doctor for birth mother."

A copy of a bill for a prenatal doctor's visit made by the same birth mother to Queen Emma Clinic in Honolulu last year showed that she was insured by Quest, Hawaii's Medicaid program, which is funded by the state and federal governments.

The records were provided by the adoptive parents, who asked not to be identified.

Virginia Frank, a Colorado attorney who has represented Adoption Choices in Hawaii and Oklahoma, said there was "no double-billing."

"We don't do that," she said.

That a birth mother was eligible for Medicaid doesn't mean the program was billed, Frank said. In some cases, she said, expenses listed in the affidavit were estimates that added up to a total fee that had been agreed to in advance. The fee agencies have been quoting for the adoption of Marshallese infants is $25,000 to $30,000.

In other cases handled by Adoption Choices, Frank said, the birth mother did not qualify for Medicaid and the agency paid for hospital and doctor expenses. Frank said birth mothers were placed in the Medicaid program to shield them from feeling they were under implicit financial pressure to go through with the adoption.

However, an agreement signed by one adoptive family that used Adoption Choices indicates that the birth mothers could be liable for medical fees.

"In the event this adoption fails," the document says, "Agency will ask Birth Mother to reimburse Clients; however, Agency cannot promise Clients a refund. Agency may, upon Clients' request, in states that allow reimbursement, file suit to attempt to recover any expenses or medical costs Clients may have incurred due to Birth Mother's representations of placing her child with their family and pay any recovered sums to Clients."

Frank acknowledged that such a provision existed in agency contracts but said it had never been invoked.

A parallel investigation of Marshallese adoptions has begun in Oklahoma, sources familiar with that inquiry said. Susan Stalling, a spokeswoman for the Oklahoma attorney general's office said she could neither confirm nor deny an investigation. Frank said she was unaware of an Oklahoma inquiry.

Court documents for an adoption arranged by Adoption Choices in Oklahoma last year were virtually identical to those in the Hawaii case. The Oklahoma records, also obtained from an adoptive parent, listed hospital expenses of $2,500 and physician expenses of $1,800. As in Hawaii, the adoptive family learned that the birth mother's bills were being charged to that state's Medicaid program.

Their signed contract with Adoption Choices explicitly stated that the birth mother would be "covered by Medicaid or private insurance."

The Hawaii attorney general's investigation is also focusing on the payment of fees to birth mothers to induce them to put their children up for adoption, sources said.

A law passed by the Pacific island nation more than a year ago makes it illegal to solicit or pay women to give up their children - born or unborn - for adoption or to facilitate their travel to another country for the purpose of adoption. But some birth mothers told The Sun that they were paid about $100 a week after being flown to Hawaii to proceed with adoptions.

Frank said Adoption Choices did not solicit birth mothers or pay them. Paying birth mothers is illegal in most states, she said.

Birth mothers "contact us. We don't contact anyone," she said.

Referring to the Hawaii investigation, Frank said, "I have documents. We have nothing to hide."

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