When seven expectant mothers in Palm Beach County had their babies delivered by midwives at Florida Woman Care, one of the largest female health care operations in the state, the cost should have been at least 20% less than what physicians charge.
Instead, Florida Woman Care documents show, the women were all billed at the higher doctor’s rate, unknowingly becoming part of an alleged billing tactic that Dr. Kenneth Konsker, a founder of the company-turned-whistleblower, says generated millions in higher — and improper — revenues.
Those seven deliveries in 2023 and 2024 represent a small portion of the billing improprieties Konsker said he has identified at Florida Woman Care in which patients were charged for seeing a doctor — care that carries a higher cost — when they actually saw a midwife or other lower-level provider.
“There’s no gray here,” Konsker told NBC News. “This is money that’s owed back to patients.”
Billing more than is appropriate for deliveries, office visits and other patient care is an example of a practice called “upcoding” — a major problem in American health care, experts say, and one reason the costs of care spiral higher every year. According to a recent report from the Government Accountability Office, improper billing practices cost taxpayers $100 billion in Medicare and Medicaid overpayments in 2023.
Upcoding can take many forms — billing for care that was not provided or for services that were not necessary are among the most common types, the government says. The Department of Justice and the Office of the Inspector General for the Department of Health and Human Services periodically bring improper billing cases, both criminally and civilly, against health care providers.
Because such upcoding practices can typically be identified only through internal documents, prosecutors often rely on insiders, like Konsker, to identify such activity.
Last year, Konsker began providing documentation of Florida Woman Care’s billing practices to state authorities and insurance companies. He compiled a spreadsheet of what he says are examples of upcoding at several Florida Woman Care operations affecting 150 patients and estimates $100 million in improper billings across the company. He said he emailed the spreadsheet to the Florida attorney general’s office and has had phone conversations with Medicaid fraud investigators there. Emails shared with NBC News show he has also sent the office documents supporting his upcoding claims.
In response to a request for comment, a spokeswoman for the Florida attorney general told NBC News that the office is investigating Florida Woman Care.
“There is an active investigation with our Medicaid Fraud Control Unit regarding Florida Woman Care,” the spokeswoman said. She declined to provide additional information.
Florida Woman Care fired Konsker without cause in May 2024, legal documents show. Konsker said in a legal filing that his termination came after he began complaining about management practices at the company, including payroll problems and other administrative issues.
That wasn’t the first time Konsker had pushed for changes at Florida Woman Care. He also did so after the Justice Department filed a complaint against the company in 2018 alleging that it had billed Medicare “for services that were inflated or that it did not provide” for more than five years.
Florida Woman Care agreed to pay $1.7 million to resolve the allegations in a settlement that made no determination of liability.
After the settlement, “I said we have to beef up compliance,” Konsker told NBC News. “The management company should be auditing all of the care centers. As you get bigger, you must have more compliance.”
Konsker said his warnings went unheeded.
A legal battle
After Konsker and his partner co-founded Florida Woman Care in Boca Raton in 2009, it grew to almost 200 locations across the state. Florida Woman Care became part of Unified Women’s Healthcare, a large OB-GYN practice management company that operates in 21 states, cares for 3 million women annually and says it is responsible for “nearly 1 in 21 births” in the U.S. It is owned by two private equity firms — Ares Management, of Los Angeles and New York City, invested first and was later joined by Altas Capital, of New York City and Toronto.
Unified did not respond to requests for comment regarding Konsker’s allegations of widespread and improper billing at Florida Woman Care. Both Altas and Ares declined to comment for this article.
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