Physician indicted, clinics settle in COVID-19 billing cases; Medicare adds nutrition specialist code; loneliness tied to fewer healthy years — Morning Medical Update

Houston physician indicted, Texas clinics settle in COVID-19 billing cases

Both cases involve office visits allegedly billed to a federal program but never performed.

Houston physician Joseph A. Montes, M.D., 66, has been indicted on 12 federal counts of conspiracy, wire fraud and money laundering in an alleged scheme to bill the Health Resources and Services Administration's (HRSA) COVID-19 Uninsured Program for office visits that never happened, the U.S. Attorney's Office for the Southern District of Texas said.

Prosecutors allege that from 2020 to 2022, co-conspirators ran pop-up COVID-19 nasal swab testing sites under Montes' name and billed for office visits instead. The scheme allegedly billed about $30 million, and HRSA paid about $20 million, including more than 9,000 claims submitted on Dec. 1, 2021, alone. An indictment is an accusation, and Montes is presumed innocent until proven guilty.

Separately, Heal 360 Urgent Care PLLC, Heal 360 Primary Care PLLC and owner Mohammed Amer Mohiuddin agreed to pay $20 million to resolve False Claims Act allegations involving the same program, the U.S. Department of Justice announced Oct. 7.

The government alleges that from Jan. 1, 2021, to March 23, 2022, the clinics billed higher-level evaluation and management visits for patients who received only nasal swabs at Texas testing sites, most of them walk-up or drive-through, and that Mohiuddin was listed as the rendering physician on most claims though he did not treat patients at the sites.

The settlement resolves two whistleblower lawsuits, and the whistleblowers will receive $3.4 million. The claims are allegations only, and there has been no determination of liability.

Nutrition specialists get their own Medicare code

The new F7 specialty code took effect Oct. 1 but does not create a new benefit.

The Centers for Medicare & Medicaid Services (CMS) has established specialty code F7 for physician nutrition specialists, effective for dates of service beginning Oct. 1, with an implementation date of Oct. 5, according to a transmittal CMS issued May 27.

Physicians self-designate their specialty when they enroll. Until the CMS-855I and CMS-855O enrollment applications and the Provider Enrollment, Chain and Ownership System are updated, Medicare contractors will accept applications that select "Undefined Physician Type" and specify physician nutrition specialist. Effective dates for the specialty cannot be earlier than Oct. 1.

The code does not create a new Medicare benefit or guarantee payment for specific services, according to the National Board of Physician Nutrition Specialists (NBPNS), which requested it with support from the American Society for Nutrition. NBPNS board member Michael M. Rothkopf, M.D., called the code "an important milestone for physicians."

Loneliness, isolation tied to fewer healthy years

A healthier lifestyle narrowed the gap linked to isolation, but not loneliness.

Adults who were both lonely and socially isolated could expect fewer years free of chronic disease than peers who were neither, according to a Tulane University-led study of 277,489 UK Biobank participants ages 40 to 69, published in Nature Communications.

At age 50, women with both lost an estimated 2.4 years free of major physical disease and 3.7 years free of depression and anxiety. Men lost 1.7 and 5.8 years, respectively. A healthier lifestyle, including diet, exercise, sleep and not smoking, narrowed the gap linked to social isolation but did not significantly change the gap linked to loneliness.

The study is observational and cannot establish cause, and the authors noted UK Biobank participants are not representative of the general population. Tulane has the news release.