After action from a whistleblower, the Florida attorney general’s office has confirmed it is investigating the healthcare group Florida Woman Care (FWC).
A spokeswoman for the office said, “There is an active investigation with our Medicaid Fraud Control Unit regarding Florida Woman Care”.
Dr. Kenneth Konsker, a founder of FWC who became a whistleblower, provided documentation to state authorities and insurers. Konsker told NBC News regarding the alleged billing issues, “There’s no gray here. This is money that’s owed back to patients.”.
Following a previous settlement regarding inflated billing, Konsker said he pushed for greater accountability, telling NBC News, “I said we have to beef up compliance … the management company should be auditing all of the care centers. As you get bigger, you must have more compliance.”
FWC spokeswoman Sheila Biggs provided a statement, saying, “Florida Woman Care is committed to delivering high-quality care to women across Florida and Georgia. As part of that commitment, FWC maintains rigorous compliance programs, including regular independent audits and mandatory provider and staff compliance training.”.
Biggs also stated that FWC “intends to vigorously defend itself as well as pursue its claims against him [Konsker],” in their ongoing legal disputes.
Insurer Aetna responded to allegations of improper billing, with a spokeswoman stating, “Aetna takes all allegations of fraud, waste, and abuse seriously and we investigate them to protect our members and customers. We’ve shared the findings of our investigation with the appropriate parties.”.
The Centers for Medicare and Medicaid Services (CMS) has referred to upcoding fraud as “a serious problem”.
CMS warned that “Committing Medicare fraud exposes individuals or entities to potential criminal, civil, and administrative liability, and may lead to imprisonment, fines, and penalties.”
Konsker advises patients to combat improper billing by checking their explanation of benefits: “If a patient gets the explanation of benefits and doesn’t see the same person on it who provided the care, they should notify the insurance company,” or CMS if the care involves Medicare or Medicaid.
Florida Woman Care fired Konsker without cause in May 2024 and 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.
“One thing I would hope is that we start looking at the healthcare system and realize how broken it is,” said Konsker.
He concluded that without scrutinizing payments for care, which he called the monetary base of the system, “then you have no ability to control costs.”