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Premier Urology Associates Agreed to Pay $266,000 for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Incident-to Services that Lacked Proper Supervision and Evaluation and Management Services Not Provided as Claimed

After it self-disclosed conduct to OIG, Premier Urology Associates, L.L.C. (Premier), New Jersey, agreed to pay $266,882.13 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that Premier submitted false or fraudulent claims to Federal health care programs as follows: (1) claims identified a physician as the rendering provider where the services were provided by a physician assistant and failed to meet "incident to" physician supervision requirements; (2) claims were submitted for evaluation and management (E&M) services using Modifier 25, on the same day as other services were billed, where medical record documentation did not support the separate E&M service charge; and (3) claims were supported by a physician for services that were already covered by global surgical package claims submitted by Premier.

Action Details

  • Date:June 2, 2015
  • Enforcement Types:
    • Fraud Self-Disclosures