FWC Urogynecology, LLC Agrees To Pay $1.7 Million To Settle False Claims Act Liability For Misuse Of Medicare Billing Codes

Orlando, FL – United States Attorney Maria Chapa Lopez announces today that FWC Urogynecology, LLC, a network of urogynecology practitioners throughout Florida, has agreed to pay the United States $1,700,000.00 to resolve allegations that it violated the False Claims Act by knowingly billing the government for services that were inflated or that it did not provide.

The settlement relates to FWC Urogynecology’s use of Medicare billing codes with modifier 25.  A provider’s use of a modifier on healthcare claims can allow additional payment from government programs.  Here, FWC Urogynecology knowingly billed modifier 25 for services that were not billable or that it did not provide. 

According to the settlement agreement, from February 1, 2012, through January 12, 2017, FWC Urogynecology knowingly billed modifier 25 to receive additional payment from the United States.  For example, FWC Urogynecology’s physicians performed and billed for lavage treatments and pelvic floor therapies and then billed modifier 25 as if they provided another service, although no additional medical care was provided. 

“A primary mission of the United States Attorney’s Office is protecting Medicare, TRICARE, and other federal health care programs from fraud,” said U.S. Attorney Maria Chapa Lopez. “Our Civil Division works tirelessly in the pursuit of providers who bill for services they do not provide to patients.”

“I applaud the Department of Justice and the U.S. Attorney for their untiring efforts to hold health care providers accountable to the American taxpayer,” said Vice Adm. Raquel Bono, director of the Defense Health Agency. “The Department of Justice’s efforts safeguard the health care benefit for American service members, veterans and their families. The Defense Health Agency continues to work closely with the Justice Department, and other state and federal agencies to investigate all those who participated in fraudulent practices.”

“Misrepresenting alleged services to inflate costs is just plain and simple greed,” said Special Agent in Charge Shimon R. Richmond of HHS OIG.  “We will continue to thoroughly investigate health care companies that engage in schemes to defraud the American taxpayer.”

The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by a former employee of an FWC Urogynecology provider, Holly Loebl. Mrs. Loebl sued under the qui tam, or whistleblower, provisions of the False Claims Act permitting a private citizen to sue on behalf of the United States for false claims and to share in the recovery. The Act also allows the United States to intervene and prosecute the action. Mrs. Loebl will receive $306,000 of the proceeds from the settlement with FWC Urogynecology.

This settlement resulted from an investigation coordinated by Assistant U.S. Attorney Jeremy R. Bloor, with assistance from the Defense Criminal Investigative Service, and the U.S. Department of Health and Human Services, Office of Inspector General.

The government’s action in this matter illustrates the emphasis on combating health care fraud, and one of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).

The case is captioned United States ex rel. Holly Loebl v. Urogynecology Specialists of Florida, LLC and Florida Woman Care, LLC, Docket Number 6:16-cv-1722-Orl-37KRS. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.