Six Rio Grande Valley doctors entered an agreement to pay $4,855,844 in order to resolve allegations they submitted false claims to Medicare, Medicaid and TRICARE which weren’t rendered or medically necessary.
The doctors include 47-year-old Javier Cabello, of San Benito, 52-year-old Ammar Halloum, of Brownsville, 54-year-old Jamil Madi, of Olmito, 62-year-old Jairo Rodriguez, of Rancho Viejo, 57-year-old Ricardo Schwarcz, of Weslaco, and 55-year-old Stanley Sy, of Pharr, who owned and operated Benchmark Inpatient Services PLLC dba Beyond Inpatient Services in Harlingen, according to a press release from the United States Attorney’s Office for the Southern District of Texas.
“Rodriguez also owned and operated Brownsville Pulmonary Center, P.A. dba Benchmark Pulmonary Center, Brownsville,” the release stated.
From Jan. 1, 2020 through May 31, 2023, these clinics and their owners allegedly submitted claims for critical care while Rodriguez allegedly submitted claims for pulmonary function testing, according to the release, which said patient medical records didn’t support these claims. Providers allegedly billed critical care for stable patients, unnecessary follow-up visits and/or services that were never performed.
The release goes on to state that Medicare doesn’t reimburse for routine pulmonary function testing and in order for the program to do so for these services, it requires providers to describe indications and presentments for the order in medical records.
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Executive Summary What’s new: In recent remarks, a key DOJ official signaled continued aggressive False Claims Act enforcement, with priorities including health care, trade fraud, antidiscrimina...