Labib Riachi, a New Jersey OB/GYN, has been excluded from participating in federal healthcare programs, including Medicare and Medicaid, for 20 years. This exclusion stems from allegations of fraudulent billing practices related to Pelvic Floor Therapy (PFT) services. The Office of Inspector General (OIG) for the U.S. Department of Health and Human Services imposed the exclusion after Riachi settled a False Claims Act case for $5.25 million.
The OIG’s Chief Counsel, Gregory E. Demske, emphasized the severity of the 20-year exclusion, highlighting the significant consequences physicians face for exploiting federal healthcare programs. Demske stated that financial penalties alone are insufficient and that exclusion is necessary to protect patients and programs. 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 female incontinence, prolapse, and other pelvic floor dysfunctions.
The OIG alleged that Riachi knowingly submitted fraudulent claims for PFT services to Medicare and Medicaid. These claims were deemed false or fraudulent due to various reasons: Riachi’s absence from New Jersey or the United States while billing for personally performed or directly supervised PFT, inadequate supervision of anorectal manometry procedures performed by medical assistants, services not provided, unqualified personnel providing physical therapy, lack of documentation, and unnecessary diagnostic services. Some claims were false for all six reasons.
Demske reiterated the OIG’s commitment to utilizing administrative tools to exclude individuals who jeopardize program integrity and patient well-being. The Social Security Act authorizes the OIG to exclude individuals or entities submitting false claims to federal healthcare programs, protecting program integrity. This exclusion reinforces the connection between False Claims Act actions and the safeguarding of federal healthcare programs.
The U.S. Attorney’s Office for the District of New Jersey reached the $5.25 million False Claims Act settlement with Riachi on February 12, 2016. Special agents and investigators from the OIG’s Office of Investigations, New York Regional Office, led the investigation. While Riachi settled, he denied any liability in the matter. The OIG legal team, including David M. Blank, Tamara T. Forys, and Jennifer A. Leonardis, along with Paralegal Mariel Filtz, represented the OIG. This case exemplifies the commitment to holding healthcare providers accountable for fraudulent billing practices.
