FWC Urogynecology, a urogynecology network based in Florida, recently settled a False Claims Act lawsuit for $1.7 million. In the suit, FWC was alleged to have billed the government for services it did not provide or were otherwise inflated to get larger refunds.
In the suit, FWC was alleged to have misused Medicare billing codes with modifier 25. Using a modifier on a healthcare claim can allow healthcare organizations to get additional payments from government programs. FWC used this modifier for services that it either did not provide or that were not billable at all.
The settlement agreement describes how FWC engaged in this knowing misuse of the modifier repeatedly from February 1, 2012 to January 12, 2017. In some cases, FWC physicians performed and billed for pelvic floor therapies and lavage treatments and billed using modifier 25 as if they had provided different services, even though they had not performed any additional care.
The lawsuit that led to the settlement was originally filed in the U.S. District Court for the Middle District of Florida by Holly Loebl, a former employee of an FWC Urogynecology provider. Loebl used the qui tam provisions of the False Claim Act to file the suit — these provisions allow private citizens to file lawsuits on behalf of the federal government for false claims and be compensated using money obtained in the resulting enforcement actions or settlements. The federal government is able to join in the case and prosecute the action as it wishes under such cases.
Lobel received $306,000 of the settlement money for her role in bringing the suit.
If you are aware of wrongdoing in a healthcare organization in which you work, you stand to earn a significant reward for providing this information to the federal government. For more information on how to proceed with a False Claims Act lawsuit, work with a knowledgeable Dallas whistleblower lawyer at Kardell Law Group.