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.
Sheila Biggs, a spokeswoman for Florida Woman Care, declined to comment on the record about the attorney general’s investigation. In a statement, she said the company is aware of Konsker’s accusations but found no evidence to support them.
“Florida Woman Care is committed to delivering high-quality care to women across Florida and Georgia,” Biggs said. “As part of that commitment, FWC maintains rigorous compliance programs, including regular independent audits and mandatory provider and staff compliance training.”
Konsker is now locked in a legal battle with Florida Woman Care. He has sued the company for defamation that he says occurred after his firing. Konsker says executives at Florida Woman Care inaccurately told his patients that he had abandoned them and his colleagues that he had mismanaged operations. FWC has sued Konsker for tortious interference related to employee agreements.
In her statement to NBC News, Biggs said Florida Woman Care “intends to vigorously defend itself as well as pursue its claims against him.”
Konsker also supplied examples of what he said were improper billing practices to Sunshine Health, an insurer for Florida’s Medicaid program; Aetna; Blue Cross and Blue Shield of Florida; and Cigna, according to emails he shared with NBC News. After initial communications with the insurers, Konsker said they went quiet.
NBC News asked all four insurers about their interactions with Konsker and whether they had investigated his allegations. Only Aetna responded.
“Aetna takes all allegations of fraud, waste, and abuse seriously and we investigate them to protect our members and customers,” a spokeswoman said in a statement. “We’ve shared the findings of our investigation with the appropriate parties.”
Identifying potential fraud
To identify the improper billing, Konsker compared two sets of documents. One is an electronic record of a patient visit completed by the provider who treated the patient, which is then sent to the insurer; the second is a copy of the explanation of benefits from the insurance company detailing reimbursements for the visit. Because both documents show who provided the care, that detail should match.
Konsker shared Florida Woman Care documents with NBC News showing roughly two dozen cases of what he said were questionable billing practices from 2017 to 2024, with 10 involving Medicaid. In those cases, the providers did not match. The reimbursement is supposed to reflect what is on the electronic record, but in these cases it did not.
Konsker says patients can do their part to combat improper billing by checking their explanation of benefits against what they experienced at their office visit or treatment.
“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,” he said, or CMS if it’s Medicare or Medicaid.
‘Unsafe medically’
After Konsker was fired last year, other physicians had to care for his bewildered patients, some of whom were counting on him to deliver their babies. He returned to work in the practice for several months taking no salary, he said, to provide continuity of care. He thought about retiring but then set up a new practice in Boca Raton and hired several colleagues eager to leave the private equity-owned Florida Woman Care.
One of them is Dr. Emily Woodbury, an OB-GYN who had worked with Konsker at Florida Woman Care since 2022. She recalled the months leading up to Konsker’s firing as a period of turmoil in the practice with staff departures and increasing animosity between Konsker and overseers at Florida Woman Care. She said her experience shows why private equity investments in health care can put both patients and physicians at risk in the pursuit of profits.
Recalling the staff meeting when Florida Woman Care executives and lawyers announced Konsker’s termination, Woodbury said she asked an urgent question. “There were 70 people in the conference room, and I asked: ‘What about the pregnant patients due tomorrow?’” Woodbury recalled.
The answer, she said, was essentially: That’s your problem.
“Private equity comes in and takes advantage — they make you, the doctor, carry the burden,” Woodbury said. “I typically deliver 10 patients a month but now there were about 50 women due to deliver each month. It was unsafe medically and legally and financially so stressful.”
Konsker’s patients, meanwhile, were frantic. Misty Paez, 34, a patient since 2008, had been closely monitoring cervical cancer risks with Konsker and treating problems successfully as they arose. In the spring of 2024, she had just received bad news and was at Konsker’s office when she learned he was no longer a part of the practice.