Six South Texas physicians and their practices agreed to pay $4.9 million to resolve allegations they submitted false claims to Medicare, Medicaid and TriCare for services that were not rendered or not medically necessary, according to a March 2 news release from the U.S. Attorney’s Office for the Southern District of Texas.
What happened?
- Javier Cabello, MD, Ammar Halloum, MD, Jamil Madi, MD, Jairo Rodriguez, MD, Ricardo Schwarcz, MD, and Stanley Sy, MD, owned and operated Benchmark Inpatient Services, doing business as Beyond Inpatient Services in Harlingen. Dr. Rodriguez also owned and operated Brownsville Pulmonary Center, doing business as Benchmark Pulmonary Center.
- From Jan. 1, 2020, to May 31, 2023, the practices and their owners allegedly submitted false claims for critical care. BPC and Dr. Rodriguez also allegedly submitted claims for pulmonary function testing.
- Critical care billing requires complex decision-making and at least 30 minutes of treatment for a critically ill or injured patient. The physicians instead allegedly billed critical care for stable patients, unnecessary follow-up visits or services they never performed. They also allegedly billed pulmonary function testing for unnecessary routine testing or services not performed.
- The settlement stems from a qui tam complaint filed under the False Claims Act. The claims resolved are allegations only, and there has been no determination of liability.
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