McALLEN, Texas – A 41-year-old primary care doctor has paid $504,588.40 to resolve allegations that he billed for excessive ultrasounds, announced U.S. Attorney Jennifer B. Lowery.
Dr. Jose Escandon operates in Mission. From Aug. 1, 2014, to Oct. 31, 2018, Escandon violated the False Claims Act by causing the submission of claims to Medicare for ultrasounds that were medically unnecessary or unreasonable.
This investigation arose out of a proactive review of claims data showing Escandon was a significant statistical outlier for ultrasound claims.
As part of the settlement, Escandon and Dr. Jose A. Escandon dba Escandon Diagnostic Clinic agreed to a three-year integrity agreement with Department of Health and Human Services – Office of Inspector General (DHHS-OIG).
The agreement promotes compliance with the Medicare statutes, program requirements and written directives and all other federal health care programs. Among other obligations, Escandon and the clinic must establish and maintain a compliance program and engage an independent organization to perform quarterly claims reviews. The agreement also requires Escandon and the clinic to routinely report on these obligations to DHHS-OIG.
The USAO jointly conducted the investigation with DHHS-OIG. Assistant U.S. Attorney Brad Gray handled the matter.
The claims resolved by the settlement are allegations only and there has been no determination of liability.