Wednesday, November 30, 2016

New Jersey OB/GYN Settles Civil Allegations on Pelvic Floor Therapy Claims, Pays $5.25 Million and Agrees to 20-Year OIG Exclusion

On 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. 

Dr. Riachi's exclusion follows a Qui Tam or False Claims Act (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. In resolving this matter through settlement, Dr. Riachi has denied any liability.

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.

Attorney Commentary: This lengthy exclusions will have a significant impact on the doctor. The government is using negotiated exclusions more and more often in civil, administrative and criminal cases with health care providers.

With this exclusion, it will be virtually impossible for the physician to get hospital privileges anywhere or to work at any practice where others treat Medicare or Medicaid patients. It also precludes him from doing any billing for any federally funded health program. Perhaps the physician was planning on retiring or changing businesses and it was not an issue for him. 

One issue we see with physicians with OIG exclusions is that with HMOs and IPAs it is sometimes difficult to tell which patients have Medicaid or Medicare. Sometimes there are violations of the exclusion rules inadvertently. One recent issue is that we have also seen OIG exclusions trigger banking regulators who will sometimes use the exclusion as a reason to deny loans or close accounts. I would assume this case also resolves any potential criminal claim and assume that the physician and his lawyers determined that this was the best result when fighting the U.S. Government. 

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law
Phone: 213-233-2260


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