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New Jersey OB/GYN Settles Fraudulent Billing Allegations, Agrees to 20-Year Exclusion from Medicare, Medicaid

November 15, 2016

A New Jersey OB/GYN, Labib Riachi, agreed to be excluded from participation in Federal health care programs, including Medicare and Medicaid, for 20 years to settle allegations by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), that Dr. Riachi submitted thousands of claims for Pelvic Floor Therapy (PFT) to Medicare and Medicaid for services that were either never provided or were otherwise false or fraudulent. The OIG exclusion follows a False Claims Act (FCA) settlement by Dr. Riachi in which he agreed to pay $5.25 million.

“Twenty years is a substantial period of exclusion and is a clear signal to physicians that they face significant consequences, beyond monetary penalties, for taking advantage of Federal health care programs and their beneficiaries,” said Gregory E. Demske, Chief Counsel to the HHS Inspector General. “In cases such as this, collecting money from a wrongdoer is not sufficient and OIG will pursue exclusion to protect our patients and programs.”

Dr. Riachi, who subspecializes in urogynecology, was the sole owner and chief operating officer of the Center of Advanced Pelvic Surgery (CAPS), a physician practice with multiple locations in New Jersey. Dr. Riachi focused part of his practice on the treatment of female incontinence, prolapse, and other pelvic floor dysfunction, often prescribing PFT for treatment.

OIG alleged that Dr. Riachi knowingly submitted claims to Medicare and Medicaid for PFT services that were not provided as claimed or were false or fraudulent for at least one the following reasons: (1) Dr. Riachi failed to personally perform or directly supervise PFT services while he was traveling outside the State of New Jersey or the United States; (2) Dr. Riachi failed to personally supervise the performance of anorectal manometry procedures performed by his medical assistants; (3) services were not actually provided; (4) physical therapy services were provided by unlicensed and unqualified individuals; (5) services were not documented; and (6) diagnostic services were not reasonable and necessary.

In some instances, Dr. Riachi’s claims were false for all six reasons.

“OIG is committed to using our administrative enforcement tools to exclude those who steal from our programs and put patients at risk of unnecessary or sub-standard care,” Mr. Demske said.

Under the Social Security Act, OIG is authorized to exclude individuals or entities that cause the submission of false or fraudulent claims to Federal health care programs. The exclusion law is applicable in nearly all conduct that forms the basis for a False Claims Act (FCA) action involving the Federal health care programs and serves to protect the integrity of these programs.

Dr. Riachi’s exclusion follows an FCA settlement agreement with the U.S. Attorney’s Office for the District of New Jersey for false billing. On February 12, 2016, Dr. Riachi agreed to resolve his FCA liability for $5.25 million.

Mr. Demske credited special agents and investigators from OIG’s Office of Investigations, New York Regional Office, under the direction of Special Agent in Charge Scott Lambert, with conducting the investigation leading to the resolution of this matter.

OIG is represented in the investigation and litigation of this matter by David M. Blank, Tamara T. Forys, and Jennifer A. Leonardis, with assistance from Paralegal Mariel Filtz.

In resolving this matter through settlement, Dr. Riachi has denied any liability.

Avoid the unknown & get checked!

Avoid the unknown & get monthly checks for Exclusion. It is better to be safe then sorry!

Applying for Reinstatement:

Reinstatement of excluded entities and individuals is not automatic once the specified period of exclusion ends. Those wishing to again participate in the Medicare, Medicaid and all Federal health care programs must apply for reinstatement and receive authorized notice from OIG that reinstatement has been granted.

To apply for reinstatement, send a written request to OIG at the address below. OIG will then provide Statement and Authorization forms that you must complete, have notarized and return. The information contained in these forms will be evaluated and a written notification of OIG’s final decision on reinstatement will be sent to you. Generally, this process requires up to 120 days to complete, but can take longer.

Excluded providers may begin the process of reinstatement 90 days before the end of the period specified in the exclusion notice letter. Premature requests will not be considered.

If reinstatement is denied, the excluded party is eligible to reapply after one year.