BROWNSVILLE, Texas — Six doctors from South Texas and their practices have agreed to pay $4,855,844 to settle allegations of submitting false claims to Medicare, Medicaid, and TRICARE, according to U.S. Attorney Nicholas J. Ganjei.
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, 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.
From January 1, 2020, to May 31, 2023, the practices allegedly submitted claims for critical care and pulmonary function testing that were either not medically necessary or not rendered at all, according to the allegations. The claims were made despite patients' medical records not supporting the care and testing billed.
Critical care billing requires complex decision-making and at least 30 minutes of treatment for critically ill or injured patients. However, the practices allegedly billed for stable patients, unnecessary follow-up visits, or services never performed. Similarly, pulmonary function testing services were billed for routine testing or services not performed, according to the allegations.
The settlement stems from a whistleblower complaint filed under the False Claims Act, which allows private...
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