Prosecutors say Heal 360 billed for high-level office visits that were never performed and generated template medical records using overseas scribes

Heal 360 Urgent Care PLLC, Heal 360 Primary Care PLLC, and their owner, Dr. Mohammed Amer Mohiuddin, have agreed to pay the United States $20 million to resolve False Claims Act allegations that they knowingly submitted or caused the submission of false claims to a federal COVID-19 program for uninsured patients, the Justice Department announced.

The allegations center on the Health Resources & Services Administration’s COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program. Prosecutors allege Heal 360 and Mohiuddin billed the program for evaluation and management services that were not performed.

“The Department is committed to rooting out fraud by healthcare providers who bill for services they did not provide,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Today’s settlement demonstrates that we will hold accountable those providers who exploit federal healthcare programs for their own financial gain.”

The Uninsured Program reimbursed eligible providers between approximately May 2020 and April 2022 for COVID-19 tests, testing-related items and services, treatment, and vaccines performed on uninsured individuals. Mohiuddin is a physician who owns the Heal 360 entities, which are medical clinics in Plano, Texas. During the COVID-19 public health emergency, Heal 360 provided healthcare services, including specimen collection for COVID-19 tests.

The settlement resolves allegations that from Jan. 1, 2021, through March 23, 2022, Heal 360 and Mohiuddin knowingly submitted or caused the submission of false claims to the Uninsured Program by billing evaluation and management services, sometimes called office visits, that were not performed.

According to the government, claims for E/M services are submitted under Current Procedural Terminology codes and vary in complexity. Higher-level codes reflect increased complexity, such as a higher level of decision-making, more detailed history, or longer duration. During the public health emergency, CMS approved the use of CPT Code 99211 for COVID-19 test specimen collection. Physicians and non-physician practitioners, including nurse practitioners, were required to use CPT Code 99211 to bill for COVID-19 specimen collection billed by clinical staff incident to their services.

By contrast, Levels 3 and 4 E/M services — CPT Codes 99203 and 99204 for new patients, and 99213 and 99214 for established patients — are higher-level codes that could not be used for mere specimen collection, the government said.

Prosecutors allege that during the public health emergency, under Mohiuddin’s oversight and direction, the Heal 360 entities operated and provided services at dozens of COVID-19 testing sites in Texas, the vast majority of which were walk-up or drive-through sites. Patients could register online or at the site to receive a COVID-19 test. At the testing sites, patients remained in their vehicles while Heal 360 staff checked them in and performed specimen collection through nasal swabs. No other medical treatment was rendered.

The United States alleges Heal 360 and Mohiuddin knew the appropriate CPT codes for the services provided at the COVID test sites were specimen collection codes, but nevertheless submitted claims under CPT codes for higher-level E/M services that were reimbursed at substantially higher rates.

To create the appearance that higher-level E/M services were being performed, Heal 360 and Mohiuddin created fictitious, template-generated medical records corresponding to the dates of service for testing, making it appear as if E/M services occurred, for example by including sections for “past medical history” and “examination,” according to the government. The charts were generated by remote scribes located overseas who input information collected at the COVID test sites into the records.

Although Mohiuddin did not visit or treat patients at the COVID test sites, he was listed on the majority of the claims as the rendering physician, the government said. Heal 360 and Mohiuddin submitted hundreds of thousands of claims to the Uninsured Program for higher-level E/M services and received payment to which they were not entitled, according to the allegations.

“We are dedicated to protecting healthcare resources from fraud,” said U.S. Attorney Jay R. Combs for the Eastern District of Texas. “When medical providers bill federal healthcare payers for unnecessary or unprovided services to increase revenue, we will use every possible tool to hold medical providers accountable and recover those funds. This case emphasizes our District’s commitment to justice by pursuing anyone who attempts to steal through misrepresentations.”

U.S. Attorney Ryan Raybould for the Northern District of Texas said the settlement reflects coordinated efforts to combat waste, fraud, and abuse in federal healthcare programs.

“The message should be crystal clear to anyone seeking to defraud federal healthcare programs — we will find you, we will find the money and assets, and we will do everything within our power to hold you accountable,” Raybould said.

Acting Deputy Inspector General for Investigations Miranda L. Bennett of the U.S. Department of Health and Human Services Office of Inspector General said billing for services never provided undermines trust in the healthcare system and diverts resources from patients who need them.

“HHS-OIG will continue working alongside law-enforcement partners to hold anyone who attempts to exploit federal healthcare programs accountable,” Bennett said.

The civil settlement resolves two cases pending in the Eastern District of Texas and Northern District of Texas filed under the qui tam or whistleblower provisions of the False Claims Act. The cases are captioned U.S. ex rel. Hooper et al. v. Heal 360 Primary Care, PLLC et al., Case No. 4:21-cv-00569 (E.D. Tex.), and U.S. ex rel. Hasan v. Heal 360 Urgent Care, PLLC et al., Case No. 3:22-cv-1333-E (N.D. Tex.). Relators will receive $3,400,000 of the proceeds from the settlement.

In addition, the government and Mohiuddin reached an agreement to resolve a related asset forfeiture proceeding initiated in the Northern District of Texas against certain real properties purchased by Mohiuddin, with proceeds from the sales of those properties credited to the civil settlement. That proceeding is captioned United States v. Real Property Known as 3300 State Highway 78, Garland, TX et al., No. 3:23-cv-2784-X.

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