Premier Medical Associates (PMA), a medical practice located in The Villages, Florida, has agreed to pay $750,000 to resolve allegations that it violated the False Claims Act. As part of the settlement, the United States contends that it has certain civil claims against PMA related to PMA’s billing of federal healthcare programs for services that were not medically necessary and reasonable. 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 U.S. Attorney Chapa Lopez. “We will continue to hold healthcare providers accountable when they misrepresent the services billed to our federal healthcare programs and their patients.”
