Heal 360 to pay $20M; DOJ alleges COVID swab-only visits were billed as level 3 and 4 E/M

On October 7, 2026, the Justice Department announced that two Plano, Texas clinics, Heal 360 Urgent Care PLLC and Heal 360 Primary Care PLLC, and their owner, Dr. Mohammed Amer Mohiuddin, agreed to pay $20 million to resolve False Claims Act allegations. The program was HRSA's COVID-19 program for the uninsured, not Medicare. The coding question is one every E/M desk knows: what level a swab-only encounter can carry.

What DOJ announced

According to the DOJ Office of Public Affairs release, Heal 360 and Mohiuddin agreed to pay $20 million to resolve allegations that they knowingly submitted or caused the submission of false claims to the Health Resources & Services Administration (HRSA) COVID-19 Uninsured Program for evaluation and management services that were not performed. DOJ says that program reimbursed eligible providers for COVID-19 testing, testing-related services, treatment, and vaccines for uninsured individuals between approximately May 2020 and April 2022.

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

What the government says happened at the test sites

The United States contends that, under Mohiuddin's oversight and direction, Heal 360 ran dozens of COVID-19 testing sites in Texas, the vast majority of them walk-up or drive-through. In the government's account, patients registered online or on site, stayed in their vehicles while staff checked them in, and received a nasal swab for a COVID-19 test. DOJ says no other medical treatment was rendered.

DOJ alleges Heal 360 and Mohiuddin knew the appropriate codes for those encounters were specimen collection codes, but billed higher-level E/M codes that paid substantially more. The release says hundreds of thousands of such claims went to the Uninsured Program.

The codes DOJ names

This release names codes, and it names them as part of the government's allegations.

DOJ says higher-level E/M codes reflect more complexity, such as a higher level of decision-making, more detailed history, or longer time, and could not be used for mere specimen collection.

Where 99211 came from during the PHE

The 99211 piece traces to CMS's May 8, 2020 interim final rule, CMS-5531-IFC at 85 FR 27550. CMS described 99211 as a level 1 established patient office visit that typically does not require the presence of a physician or other qualified health care professional, where the usual presenting problems are minimal.

Before that rule, CMS noted, 99211 was limited to patients with whom the billing practitioner had an established relationship. For the duration of the PHE, CMS allowed physicians and NPPs to bill 99211 for both new and established patients when clinical staff assessed COVID-19 symptoms and exposure and collected the specimen incident to their services. CMS added that a practitioner cannot bill for auxiliary staff services unless the incident-to requirements in 42 CFR 410.26 are met.

Why template history and exam do not set a level

DOJ alleges Heal 360 created fictitious, template-generated records to make it appear E/M services occurred, including sections for "past medical history" and "examination," and that remote scribes overseas filled them in from information collected at the sites.

The release does not say how the Uninsured Program measured E/M levels. On the Medicare side, CMS's CY 2021 Physician Fee Schedule final rule (85 FR 84472) restates the framework effective January 1, 2021: history and exam no longer select the office/outpatient E/M level. Levels 2 through 5 are selected on medical decision-making or the total time the reporting practitioner personally spent on the day of the visit. A filled-in history and exam template, on its own, is not what supports a 99203 or a 99214.

The rendering physician line

The government also alleges that although Mohiuddin did not visit or treat patients at the test sites, he was listed as the rendering physician on the majority of the claims. For a coder or biller, that is a second check next to the level: who actually furnished the service, and whether the staff-performed work meets the incident-to rules before a practitioner is billed on the line.

How the case surfaced

The settlement resolves two qui tam cases: *U.S. ex rel. Hooper et al. v. Heal 360 Primary Care, PLLC et al.*, No. 4:21-cv-00569 (E.D. Tex.), and *U.S. ex rel. Hasan v. Heal 360 Urgent Care, PLLC et al.*, No. 3:22-cv-1333-E (N.D. Tex.). DOJ says the relators will receive $3,400,000. DOJ also says the government and Mohiuddin resolved a related asset forfeiture proceeding in the Northern District of Texas (No. 3:23-cv-2784-X) against certain real properties he purchased, with sale proceeds credited to the civil settlement.

The matter was handled by the Civil Division's Commercial Litigation Branch, Fraud Section, and the U.S. Attorney's Offices for the Eastern and Northern Districts of Texas, with substantial assistance from HHS-OIG.

What this does not change

The release does not announce a new CMS rule, a Medicare audit, or a change to CPT. The CMS 99211 policy DOJ points to was tied to the PHE: CMS allowed new-patient use for COVID-19 specimen collection for the duration of the emergency. The release is an enforcement resolution about alleged E/M level selection on swab-only encounters, in a program for the uninsured. It sits next to HCC Buddy's coverage of the SMRC nursing facility E/M review, a different program and a different pattern; do not read one as the other.

Where coders should tighten this week

If your shop runs testing events, vaccine clinics, or any staff-only encounter at volume, pull the level distribution for those visit types. A swab or injection line with no practitioner visit should not show up as a 99203 or 99214. Then read a sample of the notes: does the level trace to MDM or practitioner time, or to a template's history and exam blocks? Use Evidence Check to work through what the note actually establishes before you defend a level.