Valley doctors agree to pay nearly $5 million to settle fraud allegations
Six Rio Grande Valley doctors agreed to pay nearly $5 million to settle claims they billed Medicare, Medicaid and TRICARE for services that weren't medically necessary or never happened, according to the U.S. Attorney’s Office Southern District of Texas.
The doctors — identified as 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 — owned and operated Benchmark Inpatient Services in Harlingen.
Rodriguez also ran the Brownsville Pulmonary Center.
From Jan. 1, 2020, to May 31, 2023, the doctors allegedly billed for critical care and lung function tests that medical records didn't support, according to a news release.
Critical care billing requires complex decision-making and at least 30 minutes of treatment for a critically ill or injured patient. The doctors instead billed critical care for stable patients, unnecessary follow-up visits or services they never performed, according to the allegations.
The doctors also allegedly billed for routine lung function tests that Medicare doesn't cover or for tests they never performed.
Medicare, Medicaid and TRICARE paid significantly more for the claims or paid for claims that should never have been submitted, according to the allegations.
The settlement came from a whistleblower complaint filed under the False Claims Act.
"Our country's most vulnerable deserve care based on their medical need, not on a doctor's unscrupulous desire to line their own pockets," U.S. Attorney Nicholas J. Ganjei said in a statement.
The settlement resolves allegations only and there has been no determination of liability, the news release added.