Planned Parenthood may be ordered to repay nearly $2 billion after a federal appeals court allowed a lawsuit accusing the organization of Medicaid fraud to proceed.

A full panel of judges on the U.S. Court of Appeals for the Fifth Circuit heard oral arguments in the case, which centered on Planned Parenthood’s use of Medicaid funds in Texas and Louisiana.

Jennie Bradley Lichter, president of March for Life, stated that Planned Parenthood faces a repayment obligation of close to $2 billion because it continued to fill its coffers with taxpayers’ money even after two states had disqualified it. “If that obligation stands, it will strike a serious — even existential — blow to Planned Parenthood’s national operations and potentially change the abortion landscape in this country forever,” Lichter said.

The case originated from activist David Daleiden’s release of video footage showing Planned Parenthood staff discussing the sale of aborted fetal tissue. In response, Texas and Louisiana stripped Planned Parenthood affiliates of their Medicaid qualifications.

Daleiden faced a lawsuit and prosecution for illegally recording the staff, but his actions sparked a significant pro-life movement surge and intensified efforts to weaken the nonprofit.

Planned Parenthood initially sued Texas and Louisiana and secured an injunction allowing it to continue receiving Medicaid reimbursements. However, that decision was later reversed on appeal.

An anonymous litigant then brought a new lawsuit on behalf of the two states seeking repayment for the millions of dollars Planned Parenthood collected during the injunction period.

Court documents indicate that the potential repayment — including reimbursement of Medicaid funds plus various multipliers — could total $1.8 billion, with the exact figure to be determined by a jury in the lower court.

The key issue is whether Planned Parenthood had immunity when it collected Medicaid funds. The organization argued that its legal counsel advised it to collect payments during the injunction period.

A three-judge panel initially dismissed claims related to actions taken by Planned Parenthood’s attorney-employees, ruling they have “absolute immunity” under federal common law. However, the full Fifth Circuit reversed that decision and ruled the court cannot consider the organization’s appeal at this point because the claimed immunity would not shield it from the entire lawsuit or prevent trial.

The en banc opinion rejected Planned Parenthood’s argument that the court could address attorney immunity using the collateral-order doctrine. The court determined that resolving the immunity question would not conclusively determine a separable legal issue in a way that meaningfully advances the litigation.

Additionally, neither Texas nor Louisiana state law provides jurisdiction for the Fifth Circuit in this case.

The lower court ruling was authored by Judge Matthew Kacsmaryk, a Trump appointee.