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Date: 05-21-2020

Case Style:

United States of America v. DeFazio v. Premier Urgent Care of the Villages, LLC

Case Number: 5:11-cv-00284-WTH-GJK

Judge: Wm. Terrell Hodges

Court: United States District Court for the Middle District of Florida (Hillsborough County)

Plaintiff's Attorney: United States District Attorney’s Office

Defendant's Attorney:

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Tampa, FL - The United States of America sued DeFazio v. Premier Urgent Care of the Villages, LLC on a False Claims Act violation theory.

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 health care providers accountable when they misrepresent the services billed to our federal healthcare programs and their patients.”

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.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.

Outcome: Premier Medical Associates Agree To Pay $750,000 To Resolve Claims Of False Billing

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