Illustrating the Department of Justice’s ongoing crusade against health care fraud, the United States Attorney’s Office in Orlando, Florida announced on July 2, 2018 that FWC Urogynecology, a Florida-based limited liability company comprised of numerous healthcare providers, has agreed to settle claims that it allegedly violated the False Claims Act through false billing practices. The $1.7 million settlement signifies the end of a 2016 whistleblower lawsuit originally filed in the United States District Court for the Middle District of Florida by Holly Loebl, a former employee of an FWC Urogynecology provider.  According to the settlement agreement, Loebl will receive $306,000 of the total $1.7 million settlement   The lawsuit was brought on the basis that FWC Urogynecology violated the False Claims Act by knowingly and intentionally seeking reimbursement from the government through its Medicare Part B Program for inflated and fraudulent healthcare services.

Ms. Loebl was hired by FWC Urogynecology in July of 2015 as a licensed Physician’s Assistant in their Orlando office. Loebl’s suspicions regarding fraudulent billing activity began near the beginning of her employment with FWC Urogynecology, when she noticed that many patient files contained claims for procedures that were not ordered. These initial suspicions were compounded when FWC Urogynecology’s Chief Clinical Officer allegedly asked Ms. Loebl to utilize modifier codes in order to make non-billable post-operative visits billable, and thus eligible for additional reimbursement from Medicare. Despite numerous meetings between Ms. Loebl and FWC Urogynecology regarding billing abnormalities, the company continued their allegedly fraudulent billing practices.

The qui tam provisions of the False Claims Act allow private citizens, such as Ms. Loebl, known as “relators,” with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and share in any recovery.  The relator who brings a qui tam action is entitled to receive between 15-30 percent of the Government’s total recovery – which can be as much as three times the amount the Government was defrauded, plus civil monetary penalties for each false claim for payment.

The Alleged Fraud

FWC Urogynecology provides healthcare services to individuals enrolled in the Medicare Part B Program for physicians’ services, which is a one-hundred percent federally subsidized health insurance program.  For a claim to be paid by Medicare, the claim must identify each patient-provided service by a corresponding code listed in the Current Procedural Terminology (“CPT”), which is disseminated to healthcare providers by the American Medical Association. The Medicare Part B Program reimburses healthcare providers based upon a specific amount of money corresponding to a CPT code for the patient-provided service.  In order for a provider to be eligible for additional payment from the Medicare Part B Program regarding healthcare claims, a provider utilizes a special billing claim called a “modifier.”

According to the settlement agreement, from February 1, 2012 to January 12, 2017, FWC Urogynecology knowingly and deliberately billed for services that where scheduled, but not actually performed and charted in order to receive additional reimbursements from the government through its Medicare Part B Program. The allegations included that FWC’s physicians performed and billed for lavage treatments and pelvic floor therapies, but utilized an improper billing code, modifier 25, to receive additional payments.

Frohsin Barger & Walthall would like to thank and congratulate Ms. Holly Loebl for her perseverance in bringing the original lawsuit that led to the settlement agreement, as well has her counsel Robert F. Spohrer of Spohrer & Dodd P.L. in Jacksonville, Florida and David J. Rodziewicz of Rodziewicz Law P.L. in Daytona Beach, Florida. Frohsin Barger & Walthall would also like to thank and congratulate the United States Attorney’s Office for the Middle District of Florida for their efforts in holding healthcare providers to a high standard of accountability to taxpayers.

Read the United States Attorney’s Office for the Middle District of Florida’s press release here.

For more information on the False Claims Act, click here.