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The Villages
Monday, December 11, 2023

Premier Medical Associates to pay $750,000 to resolve claims of false billing

Premier Medical Associates of The Villages has agreed to pay $750,000 to resolve claims of false billing.

As part of the settlement, the government contends that it has certain civil claims against Premier Medical Associates related to Premier Medical Associates’s billing of federal healthcare programs for services that were not medically necessary and reasonable.

United States Attorney Maria Chapa Lopez said that Premier Medical Associates violated the False Claims Act.

Specifically, the government alleges that PMA knowingly billed for higher and more expensive levels of medical services than were actually performed and also billed for certain claims using “modifier 25,” indicating that a separate evaluation and management service was performed, even when there was no such separate service.

“This settlement reflects our continuing efforts to protect patients and taxpayers by ensuring that the care provided to beneficiaries of government-funded healthcare programs is dictated by patient needs, not a provider’s financial gain,” said Lopez. “We will continue to hold health care providers accountable when they misrepresent the services billed to our federal healthcare programs and their patients.”

She added that the resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints 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).

This matter was investigated by the U.S. Department of Health and Human Services-Office of Inspector General. It was handled by Assistant United States Attorney Sean Keefe.

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