Investigation into Billing Practices at Florida Woman Care
In a troubling series of events, seven expectant mothers in Palm Beach County discovered they were billed at doctor rates for deliveries that were conducted by midwives at Florida Woman Care, a major health care provider in Florida. These charges are alleged to be part of a broader scheme aimed at inflating costs beyond the appropriate levels, as described by Dr. Kenneth Konsker, one of the company’s founders who later became a whistleblower.
The Allegations
Despite the expectation that midwife-assisted deliveries would cost at least 20% less than similar services provided by physicians, documentation from Florida Woman Care indicates that these women were charged the higher rates associated with doctors. Konsker argues that this practice has contributed to millions of dollars in inappropriate revenue generation.
“There’s no gray here,” Konsker stated in an interview with NBC News. “This is money that’s owed back to patients.”
Understanding Upcoding
This practice of billing for services at inflated rates is commonly referred to as “upcoding.” Health care experts identify it as a significant contributor to rising medical expenses in the United States. A report from the Government Accountability Office highlighted that improper billing practices resulted in approximately $100 billion in overpayments from Medicare and Medicaid in 2023 alone.
Examples of Improper Billing
Upcoding can manifest in various ways, including:
- Billing for services that were never provided
- Charging for unnecessary procedures
In many cases, these transgressions can only be exposed through internal records, which is why whistleblowers like Konsker play a crucial role in shedding light on these issues.
Whistleblower’s efforts
Starting in 2023, Konsker began compiling evidence of the alleged upcoding practices at Florida Woman Care, focusing on over 150 patients and estimating that the company may have engaged in about $100 million of improper billings. He has forwarded this information to state authorities and insurance companies, including a spreadsheet outlining specific instances of upcoding. The Florida attorney general’s office has confirmed that an investigation into Florida Woman Care is currently underway.
“There is an active investigation with our Medicaid Fraud Control Unit regarding Florida Woman Care,” a spokesperson for the attorney general’s office confirmed.
Background on Florida Woman Care
Founded in 2009, Florida Woman Care has expanded to nearly 200 locations across Florida and operates under the umbrella of Unified Women’s Healthcare, a sizable OB-GYN practice management entity. This organization, which tends to around 3 million women annually, is backed by private equity firms Ares Management and Altas Capital.
In 2018, Florida Woman Care faced scrutiny from the Department of Justice for alleged deceptive billing practices that dated back over five years. The company ultimately reached a settlement of $1.7 million, although it did not admit liability.
Ongoing Developments
Following Konsker’s whistleblower activities, he was terminated without cause in May 2024. He had previously raised concerns regarding various management practices at the company, emphasizing the need for enhanced auditing and compliance measures in light of its rapid growth.
Despite his previous warnings, Konsker noted that management did not take the steps he recommended to prevent further discrepancies. Responses from Unified Women’s Healthcare and the private equity firms involved have been limited, with both Ares and Altas declining to comment on these serious allegations.
Conclusion
The unfolding investigation into Florida Woman Care underscores significant issues regarding billing practices in the U.S. health care system, a concern that not only affects individual patients but also contributes to escalating health care costs nationwide. As developments continue, the importance of vigilance and accountability in health care billing practices becomes ever more critical.
