A whistleblower exposed alleged upcoding at Florida Woman Care, prompting investigations.
Dr. Kenneth Konsker, once a co-founder of Florida Woman Care, claims the healthcare organization overbilled patients for years, creating millions in extra revenue for the private equity firms that now own the company. Konsker, who became a whistleblower, says patients were charged higher doctor rates even when they were treated by midwives or other lower-level providers. His allegations cover office visits, prenatal care, deliveries, and other services, suggesting widespread misuse of billing practices at the women’s care facility known as “upcoding.”
Upcoding occurs when providers bill for care that is more expensive than what was actually delivered. In the United States, this practice drives up healthcare costs and strains public programs. The Government Accountability Office reported in 2023 that improper billing cost taxpayers about $100 billion in Medicare and Medicaid overpayments. Experts say such practices often remain hidden until insiders come forward with documentation, making whistleblowers like Konsker vital in uncovering potential fraud.
Konsker began sending evidence to the Florida attorney general and several insurance companies last year, highlighting examples he estimates affect more than 150 patients and could involve over $100 million in improper billing. He shared spreadsheets comparing patient records with insurers’ explanations of benefits, noting discrepancies where care listed in the records did not match what insurance documents reflected. In some cases, midwives performed deliveries, but the bills listed doctors instead, inflating charges without medical justification.
The Florida attorney general confirmed an active investigation into Florida Woman Care through its Medicaid Fraud Control Unit. Meanwhile, Florida Woman Care has denied wrongdoing, stating it found no evidence supporting Konsker’s claims. The company emphasized that it maintains compliance programs, audits, and staff training to ensure proper billing. The private equity firms that own the company, Ares Management and Altas Capital, have declined to comment.
Konsker was terminated by Florida Woman Care in May 2024 after raising concerns about billing, payroll, and administrative practices. His firing triggered legal disputes. He filed a defamation suit against the company, claiming executives spread false information to patients and colleagues, while the company sued him for allegedly interfering with employee agreements.
Following his departure, Konsker briefly returned to work without pay to support patients in the practice, many of whom were expecting babies. One former colleague, Dr. Emily Woodbury, described a chaotic environment in which staff faced heavy workloads and patients risked unsafe care. Woodbury said, “Private equity comes in and takes advantage — they make you, the doctor, carry the burden.” She noted that doctors who usually managed ten deliveries a month were suddenly responsible for fifty, creating stress and safety concerns.
Patients were left anxious by the sudden changes. Misty Paez, a longtime patient, said she feared for her health when she learned Konsker was no longer part of the practice. She now follows his care at his new Boca Raton clinic, where she credits him with preserving her ability to have children in the future.
Konsker warns that profit pressures from private equity ownership can push medical practices into unsafe financial and clinical situations. He believes that careful oversight of billing and transparency in patient charges are essential to controlling costs and protecting patient care. His allegations highlight the ongoing tension between corporate ownership, healthcare costs, and patient safety, illustrating the challenges in ensuring ethical practices in large healthcare organizations. This case draws attention to the importance of monitoring billing practices and supporting whistleblowers who expose wrongdoing, as unchecked financial incentives can compromise both patient safety and trust in the healthcare system.
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