South Texas Doctors to Pay Nearly $5 Million to Settle False Claims Allegations

Six doctors in the Rio Grande Valley of South Texas have agreed to pay a combined $4,855,844 to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE. The claims involved services that were either not medically necessary or were never provided, according to the U.S. Attorney’s Office for the Southern District of Texas.

Who is Involved?

The doctors involved in the settlement are:

• Javier Cabello, 47, of San Benito
• Ammar Halloum, 52, of Brownsville
• Jamil Madi, 54, of Olmito
• Jairo Rodriguez, 62, of Rancho Viejo
• Ricardo Schwarcz, 57, of Weslaco
• Stanley Sy, 55, of Pharr

The doctors owned and operated Benchmark Inpatient Services PLLC, doing business as Beyond Inpatient Services in Harlingen. Rodriguez too owned and operated Brownsville Pulmonary Center, P.A. Dba Benchmark Pulmonary Center in Brownsville. U.S. Department of Justice

What Allegations Were Made?

From January 1, 2020, through May 31, 2023, the clinics and doctors allegedly billed for critical care services and pulmonary function testing that lacked proper medical support. Specifically, prosecutors allege that:

• Critical care was billed for patients who were stable, during routine follow-up visits, or for services that never occurred.
• Pulmonary function testing was billed as routine or for services that were never performed. Medicare does not cover routine pulmonary function testing unless there are documented medical indications. Hoodline

Impact of the False Claims

As a result of these alleged fraudulent claims, Medicare, Medicaid, and TRICARE improperly paid for services that were not justified. The $4,855,844 settlement aims to recover these funds.

Whistleblower Component

The settlement originated from a whistleblower complaint filed under the False Claims Act. The whistleblower could receive up to 30% of the government’s recovery.

Official Statements

U.S. Attorney for the Southern District of Texas, Nicholas J. Ganjei, stated, “Our country’s most vulnerable deserve care based on their medical need, not on a doctor’s unscrupulous desire to line their own pockets. Medical professionals have a solemn obligation to heal the sick and infirm, not to bilk the American taxpayer.” U.S. Department of Justice

The investigation involved the HHS Office of Inspector General, the FBI, the Defense Criminal Investigative Service, and the Texas Attorney General’s Civil Medicaid Fraud Division.