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Florida Health Care Group Pays $1.7 Million Settlement in Medicare False Claims Suit

The U.S. Department of Justice ("DOJ") announced on July 2, 2018, that FWC Urogynecology LLC ("FWC"), a network of urogynecologists in Florida, has agreed to pay $1.7 million to settle claims that it violated the False Claims Act ("FCA"). The United States notified the court of its intent to intervene and prosecute the suit on May 16, 2018.

The government accused FWC of intentionally billing Medicare for services never performed and for unnecessarily large amounts. The DOJ alleged the network of practitioners included modifier 25 on their billing submissions, which indicates the doctor completed separate, additional services during an appointment. The doctors, however, did not actually perform these additional services, but the modifier allowed them to receive extra Medicare reimbursements.

Special Agent in Charge, Shimon R. Richmond, with the U.S. Department of Health and Human Services' Office of the Inspector General, commented that "[m]isrepresenting alleged services to inflate costs is just plain and simple greed. We will continue to thoroughly investigate health care companies that engage in schemes to defraud the American taxpayer."

FWC carried out its fraudulent practices between February 1, 2012, and January 12, 2017. The agreed-upon settlement will resolve the claims. However, defendants Urogynecology Specialists of Florida, based in Orlando, and its owner, Florida Woman Care LLC, of Boca Raton, were not found liable.

The case is a product of a September 30, 2016 whistleblower suit filed by Holly Loebl ("Loebl"). Loebl was a physician's assistant at an FWC-affiliated practice and currently has a pending wrongful termination claim against the defendants in a different federal suit.

While employed under the FWC provider, Loebl was pressed to "upcode" patient interactions to more expensive services so the practice could increase the amount it billed the government. She also alleged in an amended complaint filed March 8 that patient files contained claims for services that were scheduled but yet to be performed and for services never ordered in the first place.

According to the complaint, one billing sheet submitted at the time the patient checked out showed a post-operative visit with no charge. However, the sheet was later changed to show procedures qualifying for reimbursement, as well as the aforementioned modifier 25 code, indicating another separate service was performed. Another patient's chart noted that the woman's cervix and uterus appeared normal, indicating the performance of an exam, even though the patient in question had previously undergone a hysterectomy.

Counsel for Loebl explained that "[c]ases like these are important because our system of health care reimbursement works on the honor system. If an enterprise cheats on their [sic] billing, as alleged, we all lose. The reimbursement money comes from all of the American people in the form of our tax dollars."

Counsel also asserted that Loebl incurred great risk in coming forward as a whistleblower. Her pending wrongful termination case alleges that "defendants terminated Mrs. Loebl's employment shortly after she questioned their billing practices. She suffered periods of unemployment; her family had to do without." The government is awarding Loebl $306,000 of the July settlement for her actions.

The legal team at Shepherd, Finkelman, Miller & Shah, LLP ("SFMS") has significant experience litigating false claims and qui tam matters. If you have any questions regarding this subject or this posting, please contact Nick Lussier ([email protected]) or Chiharu Sekino ([email protected]). We can also be reached toll-free at (866) 540-5505.

SFMS is a law firm with offices in California, Connecticut, Florida, New Jersey, New York, and Pennsylvania. SFMS is an active member of Integrated Advisory Group (www.iaginternational.org), which provides us with the ability to provide our clients with access to excellent legal and accounting resources throughout the globe. For more information about our firm, please visit us at www.sfmslaw.com.

Sources

Hale, Nathan. "Health Care Group Settles FCA Medicare Claims for $1.7M." Law 360. Last modified on July 2, 2018.

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