Heal 360 Settles False Claims Allegations for $20 Million

Heal 360 Urgent Care PLLC and Heal 360 Primary Care PLLC, owned by Dr. Mohammed Amer Mohiuddin, have agreed to pay $20 million to the United States to settle allegations of submitting false claims related to COVID-19 services. The allegations, resolved under the False Claims Act, involve claims made to the Health Resources & Services Administration's COVID-19 Claims Reimbursement Program for services that were not provided.

The U. S. Department of Justice announced the settlement, emphasizing its commitment to combating fraud in federal healthcare programs.

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

Allegations and Settlement

The allegations against Heal 360 and Dr. Mohiuddin claim that they knowingly submitted false claims for evaluation and management services that were never performed. These claims were made under the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program. The settlement resolves these allegations without an admission of liability.

Between May 2020 and April 2022, the Uninsured Program reimbursed eligible providers for COVID-19 tests, related services, treatment, and vaccines for uninsured individuals. The allegations specifically cover the period from January 1, 2021, to March 23, 2022, during which Heal 360 allegedly billed for services not rendered using higher-level Current Procedural Terminology (CPT) codes meant for more complex services.

Government's Response

U.S. Attorney Jay R. Combs for the Eastern District of Texas remarked on the importance of protecting healthcare resources from fraud, stating, "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."

The settlement was achieved through the combined efforts of civil fraud and asset forfeiture prosecutors from multiple districts and the investigative work of the HHS Office of Inspector General. Acting Deputy Inspector General for Investigations Miranda L. Bennett highlighted the significance of ensuring federal funds are used appropriately, noting that "billing for services that were never provided undermines trust in the health care system and diverts resources from patients who need them."

The resolution of this case underscores the government's dedication to using all available tools to combat waste, fraud, and abuse in federal healthcare programs, ensuring that funds dedicated to public health emergencies are used appropriately.