Six South Texas Doctors, False Claims Act, Texas 2023

South Texas doctors agree to pay nearly $5 million to settle False Claims Act liability. The six doctors, who owned and operated Benchmark Inpatient Services PLLC dba Beyond Inpatient Services in Harlingen, allegedly submitted false claims to Medicare, Medicaid, and TRICARE for critical care and pulmonary function testing that were not rendered or not medically necessary.

The defendants, Drs. Javier Cabello, Ammar Halloum, Jamil Madi, Jairo Rodriguez, Ricardo Schwarcz, and Stanley Sy, allegedly submitted claims for critical care and pulmonary function testing from Jan. 1, 2020, to May 31, 2023. Patients’ medical records allegedly did not support this care and testing, or the care was not rendered at all.

Critical care billing requires complex decision-making and at least 30 minutes of treatment for a critically ill or injured patient. The defendants allegedly billed critical care for stable patients, unnecessary follow-up visits, or services they never performed. Pulmonary function testing services include various tests that demonstrate how well the lungs function. The defendants allegedly billed these services for unnecessary routine testing or services they never performed.

As a result, Medicare, Medicaid, and TRICARE either paid significantly more for critical care claims or for PFT claims that should never have even been made 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,” said U.S. Attorney Nicholas J. Ganjei. “Our country’s most vulnerable deserve care based on their medical need, not on a doctor’s unscrupulous desire to line their own pockets.”

The settlement stems from a qui tam or 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 investigation was conducted by DHHS-OIG, FBI, Defense Criminal Investigative Service, and Texas Attorney General’s Office – Civil Medicaid Fraud Division. Assistant U.S. Attorney Laura E. Collins handled the matter.

The claims resolved by the settlement are allegations only and there has been no admission of wrongdoing by the defendants. The settlement amounts to $4,855,844.

Source: https://www.justice.gov/usao-sdtx/pr/south-texas-doctors-agree-pay-nearly-5-million-settle-false-claims-act-liability