Texas clinics, owner pay $20M to resolve False Claims Act COVID-19 allegations

A physician and his two Plano, Texas, clinics have agreed to pay the federal government $20 million to resolve allegations that they billed a COVID-19 relief program for evaluation and management services that were never performed, the Justice Department announced.

Heal 360 Urgent Care PLLC, Heal 360 Primary Care PLLC and their owner, Dr. Mohammed Amer Mohiuddin, settled False Claims Act allegations involving a federal program that reimbursed providers for COVID-19 testing, treatment and vaccines for uninsured patients. The program was administered by the Health Resources & Services Administration. The claims at issue date from Jan. 1, 2021, through March 23, 2022.

The government alleges the clinics operated dozens of COVID-19 testing sites in Texas under Mohiuddin’s oversight and direction, most of them walk-up or drive-through locations. Patients remained in their vehicles while staff checked them in and collected nasal swabs, and no other medical treatment was provided, according to the allegations.

During the public health emergency, the Centers for Medicare & Medicaid Services approved CPT Code 99211 for COVID-19 test specimen collection. Physicians and non-physician practitioners were required to use that code for specimen collection performed by clinical staff incident to their services, the department said.

The government alleges Heal 360 and Mohiuddin knew the services warranted specimen collection codes but instead submitted claims using higher-level evaluation and management codes. Those codes reimbursed at substantially higher rates and could not be used for mere specimen collection, the department said.

To make it appear those services occurred, Heal 360 and Mohiuddin allegedly created fictitious, template-generated medical records with sections such as “past medical history” and “examination.” Remote scribes overseas filled in the charts using information collected at the testing sites, according to the government’s allegations.

The government further alleges that Mohiuddin did not visit or treat patients at the testing sites but was listed as the rendering physician on most claims. Heal 360 and Mohiuddin allegedly submitted hundreds of thousands of claims for higher-level services and received payments to which they were not entitled.

“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.

U.S. Attorney Ryan Raybould for the Northern District of Texas credited the combined work of civil fraud and asset forfeiture prosecutors, along with investigators from the Department of Health and Human Services Office of Inspector General.

Miranda L. Bennett, acting deputy inspector general for investigations at HHS-OIG, said billing for services never provided “undermines trust in the health care system.”

The settlement resolves two whistleblower lawsuits filed in the Eastern and Northern districts of Texas under the False Claims Act’s qui tam provisions. The whistleblowers will receive $3.4 million of the proceeds. The government and Mohiuddin also reached an agreement resolving a related asset forfeiture proceeding involving properties he purchased, with proceeds from their sales credited toward the settlement.

The Justice Department said its False Claims Act enforcement supports the Task Force to Eliminate Fraud and the National Fraud Enforcement Division, both launched this year.

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