Heal 360 Urgent Care PLLC, Heal 360 Primary Care PLLC (together “Heal 360”) and their owner, Dr. Mohammed Amer Mohiuddin (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 the Health Resources & Services Administration COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (the “Uninsured 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.”
“We are dedicated to protecting healthcare resources from fraud,” said U.S. Attorney Jay R. Combs of 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.”
“This settlement is a great example of this Administration’s commitment to using all available tools at its disposal to combat waste, fraud, and abuse in federal healthcare programs,” said U.S. Attorney Ryan Raybould for the Northern District of Texas. “Through the combined efforts of civil fraud and asset forfeiture prosecutors from my office, civil fraud prosecutors in the Eastern District of Texas and at Main Justice, and outstanding investigative work by our agency partners at the HHS Office of Inspector General, we were able to secure this substantial recovery for the benefit of the American taxpayer. 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.”
“Ensuring federal funds dedicated to public health emergency response are used appropriately is a core oversight priority for HHS‑OIG,” said Acting Deputy Inspector General for Investigations Miranda L. Bennett of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Billing for services that were never provided undermines trust in the health care 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.”
Between approximately May 2020 and April 2022, the Uninsured Program reimbursed eligible providers 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 (PHE), Heal 360 provided healthcare services, including specimen collection for COVID-19 tests. The settlement announced today 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 (E/M Services) that were not performed.
As alleged by United States, claims for E/M Services, sometimes referred to as “office visits,” are submitted under Current Procedural Terminology (CPT) Codes, and vary in level of complexity. Higher level codes reflect increased complexity, such as a higher level of decision-making, more detailed history, or longer duration of time. During the COVID Public Health Emergency (PHE), CMS approved the use of CPT Code 99211 for COVID-19 test specimen collection. Physicians and non-physician practitioners, such as nurse practitioners (NPs) 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 (i.e. CPT Codes 99203 and 99204 for new patients, and 99213 and 99214 for established patients) are codes for higher level E/M services (the “Higher Level E/M Services”) that could not be used for mere specimen collection.
The United States contends that during the PHE, 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 testing sites (the “COVID test sites”). Patients could register online or at the site to receive a COVID-19 test, and at the COVID test sites, patients remained in their vehicles while Heal 360 staff checked them in and performed specimen collection services through nasal swabs for COVID-19 tests. No other medical treatment was rendered.
The United States alleges that Heal 360 and Mohiuddin knew that 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 than reimbursements for specimen collection.
In order to create the appearance that Higher Level E/M Services were being performed, Heal 360 and Mohiuddin created fictitious, template-generated medical records to correspond to the dates of service for testing that made it appear as if E/M services occurred, for example by including sections for “past medical history” and “examination.” 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 tests sites, he was listed on the majority of the claims as the rendering physician. Heal 360 and Mohiuddin submitted hundreds of thousands of claims by the Heal 360 entities to the Uninsured Program for Higher Level E/M Services, and as a result received payment to which they were not entitled.
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, which permit private parties to file an action for false claims on behalf of the United States and share any recovery. The qui tam cases are captioned U.S. ex rel. Hooper at 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 have 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 being credited to the civil settlement. The asset forfeiture 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 resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the U.S. Attorney’s Offices for the Eastern District of Texas and Northern District of Texas, with substantial assistance from HHS-OIG. This matter was handled by Civil Division Fraud Section Trial Attorney Elizabeth J. Kappakas and by Assistant U.S. Attorneys James Gillingham and Kevin McClendon for the Eastern District of Texas, Brian Stoltz and Najib Gazi for the Northern District of Texas, and John Penn for the forfeiture proceeding in the Northern District of Texas.
This year the Administration launched the Task Force to Eliminate Fraud and the National Fraud Enforcement Division to enhance the Administration’s war on fraud, waste, and abuse in federal programs. When unscrupulous actors exploit these programs for their own financial gain, they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules. The Civil Division’s FCA enforcement plays a critical role in combatting such fraudulent schemes, recovering billions of dollars for the American taxpayers, and holding wrongdoers accountable. FCA matters will continue to be on the forefront of the battle against fraud, and the Civil Division’s FCA work will support and advance the mission of the Task Force to Eliminate Fraud and the National Fraud Enforcement Division.
The claims resolved by the settlement are allegations only and there has been no determination of liability.