South Texas Doctors Pay $4.8 Million to Settle False Federal Healthcare Claims

Six South Texas doctors have agreed to pay nearly $5 million to settle allegations of healthcare fraud, according to the United States Attorney’s Office for the Southern District of Texas.

U.S. Attorney Nicholas J. Ganjei announced the $4,855,844 settlement involving 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. The physicians owned and operated Benchmark Inpatient Services PLLC, doing business as Beyond Inpatient Services in Harlingen. Dr. Rodriguez additionally operated Brownsville Pulmonary Center.

The settlement addresses allegations that between January 2020 and May 2023, the doctors and their practices submitted fraudulent claims to Medicare, Medicaid, and TRICARE—the three major federal healthcare programs. These claims were for services either never provided or deemed medically unnecessary.

Federal investigators found that Beyond Inpatient Services systematically billed for critical care services that patient records did not support. Critical care billing requires complex decision-making and at least 30 minutes of direct treatment for critically ill patients. Instead, the doctors allegedly billed for critical care when treating stable patients, conducting routine follow-ups, or in some cases, for services never performed at all.

Benchmark Pulmonary Center and Dr. Rodriguez faced additional allegations regarding pulmonary function testing. These specialized respiratory assessments are reimbursable by Medicare only when medically necessary to diagnose new symptoms or evaluate current treatments. Investigators claim the center routinely billed for unnecessary tests or for services that were never actually delivered to patients.

“This outcome emphasizes the Southern District of Texas’s commitment to vigorously investigate and disrupt civil health care fraud, wherever it may be,” Ganjei stated. “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 case highlights a growing concern within the healthcare industry about improper billing practices, particularly in specialized care. The COVID-19 pandemic created unprecedented pressure on healthcare systems, but also opportunities for fraud as regulations were temporarily relaxed and attention was diverted to emergency response.

Jason E. Meadows, special agent in charge of the Department of Health and Human Services Office of Inspector General, emphasized the broader significance of the settlement: “We remain steadfast in our mission to protect patients and safeguard federal health care programs. This settlement underscores our commitment to holding providers accountable when they submit claims for services that are not medically necessary or not actually provided.”

The FBI also played a key role in the investigation. Alex Doran, acting special agent in charge of the FBI’s San Antonio Field Office, noted that the timing of the fraud during the pandemic made it particularly egregious. “Submitting false claims to federal health care programs during a national emergency such as the COVID-19 pandemic steals from taxpayers and exploits vulnerable patients,” Doran said.

The investigation originated from a whistleblower complaint filed under the False Claims Act, which allows private citizens to file lawsuits on behalf of the government against those who defraud federal programs. The whistleblower provision includes incentives for reporting fraud, allowing the individual who filed the complaint to receive a portion of any recovered funds.

The case was investigated by multiple agencies, including the Department of Health and Human Services Office of Inspector General, the FBI, the Defense Criminal Investigative Service, and the Texas Attorney General’s Office Civil Medicaid Fraud Division. Assistant U.S. Attorney Laura E. Collins handled the matter for the prosecution.

Healthcare fraud costs American taxpayers billions of dollars annually and diverts resources from patients who genuinely need care. The South Texas case illustrates the federal government’s ongoing commitment to combat such fraud through coordinated multi-agency investigations and substantial financial settlements.