CORPUS CHRISTI, Texas — Six South Texas doctors and their medical practices have agreed to pay $4,855,844 to resolve allegations they submitted false claims to Medicare, Medicaid and TRICARE for services that were either never provided or not medically necessary, according to a press release from the United States Attorney’s Office - Southern District of Texas.
U.S. Attorney Nicholas J. Ganjei announced the settlement involving Drs. 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; and Stanley Sy, 55, of Pharr. The six doctors owned and operated Benchmark Inpatient Services PLLC, doing business as Beyond Inpatient Services, in Harlingen. Rodriguez also owned and operated Brownsville Pulmonary Center, P.A., doing business as Benchmark Pulmonary Center, in Brownsville.
According to allegations, from Jan. 1, 2020, to May 31, 2023, Beyond Inpatient Services, Benchmark Pulmonary Center and their owners submitted claims for critical care services that patients' medical records did not support, or that were never rendered at all. Benchmark Pulmonary Center and Rodriguez also allegedly submitted claims for pulmonary function testing during that period.
Critical care billing requires complex decision-making and at least 30 minutes of treatment for a critically ill or injured patient. Instead, Beyond Inpatient Services providers allegedly billed critical care for stable patients, unnecessary follow-up visits, or services they never performed.
Pulmonary function testing services include various tests that measure how well the lungs function. When medically necessary, those services either diagnose and evaluate new respiratory symptoms or assess a patient's current therapeutic respiratory interventions. Medicare does not reimburse for routine pulmonary function testing. For Medicare to reimburse for medically necessary pulmonary function testing, providers must document the indications and presentments for the order in the patient's medical record. Benchmark Pulmonary Center and Rodriguez instead allegedly billed for unnecessary routine testing or services never performed.
As a result, Medicare, Medicaid and TRICARE either paid significantly more for critical care claims or for pulmonary function testing claims that should never have been submitted to the government programs.
"This outcome emphasizes the Southern District of Texas's commitment to vigorously investigate and disrupt civil health care fraud, wherever it may be," Ganjei said. "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."
Jason E. Meadows, special agent in charge of the Department of Health and Human Services Office of Inspector General, also commented on the settlement.
"We remain steadfast in our mission to protect patients and safeguard federal health care programs," Meadows said. "This settlement underscores our commitment to holding providers accountable when they submit claims for services that are not medically necessary or not actually provided. We will continue to work closely with our law enforcement partners to ensure that taxpayer-funded programs are protected from fraud and abuse."
Alex Doran, acting special agent in charge of the FBI San Antonio Field Office, addressed the broader implications of the case.
"Fraud against the government will not be tolerated," Doran said. "Submitting false claims to federal health care programs during a national emergency such as the COVID 19 pandemic steals from taxpayers and exploits vulnerable patients. The FBI, together with its federal and state partners, will hold accountable anyone who seeks to profit by defrauding the United States."
The settlement stems from a whistleblower complaint filed under the False Claims Act, which permits a private party to file an action on behalf of the United States and receive a portion of any recovery.
The Department of Health and Human Services Office of Inspector General and the FBI conducted the investigation with assistance from the Defense Criminal Investigative Service and the Texas Attorney General's Office Civil Medicaid Fraud Division. Assistant U.S. Attorney Laura E. Collins handled the matter.
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