Labib Riachi, a New Jersey OB/GYN, has been excluded from participating in federal healthcare programs, including Medicare and Medicaid, for 20 years. This significant penalty follows allegations of fraudulent billing practices related to Pelvic Floor Therapy (PFT) services. The Office of Inspector General (OIG) imposed the exclusion after Riachi agreed to a $5.25 million settlement under the False Claims Act (FCA).
Riachi’s Fraudulent Billing Scheme Targeted Pelvic Floor Therapy
Riachi, specializing in urogynecology, owned and operated the Center of Advanced Pelvic Surgery (CAPS) with multiple locations in New Jersey. He frequently prescribed PFT for conditions like female incontinence and pelvic floor dysfunction. The OIG investigation revealed a pattern of fraudulent billing for these services. Riachi submitted thousands of claims to Medicare and Medicaid for PFT services that were either not provided or were falsely represented.
Multiple Reasons for Fraudulent Claims by Riachi
The OIG outlined several reasons why Riachi’s claims were deemed fraudulent. These included billing for services while he was out of the country or state, failing to properly supervise medical assistants performing procedures, billing for services not rendered, employing unqualified individuals to provide physical therapy, lacking proper documentation, and billing for unnecessary diagnostic services. In some cases, claims were false for all six reasons. This extensive and systematic fraud resulted in significant financial harm to federal healthcare programs.
OIG Excludes Riachi to Protect Patients and Programs
The OIG emphasized that the 20-year exclusion serves as a strong deterrent against healthcare fraud. Gregory E. Demske, Chief Counsel to the HHS Inspector General, stated that financial penalties alone are insufficient in such cases. Exclusion is necessary to protect patients and the integrity of federal healthcare programs. Riachi’s exclusion underscores the OIG’s commitment to holding healthcare providers accountable for their actions.
Riachi’s Exclusion Follows $5.25 Million Settlement
The exclusion follows a February 2016 settlement with the U.S. Attorney’s Office for the District of New Jersey, where Riachi agreed to pay $5.25 million to resolve his FCA liability. While Riachi denied liability in the settlement, the OIG’s investigation and subsequent exclusion demonstrate a clear pattern of fraudulent billing. This case serves as a warning to other healthcare providers who might consider engaging in similar practices. The OIG will continue to actively pursue individuals and entities who defraud federal healthcare programs.
