Westfield OB/GYN Settles Fraudulent Billing Allegations, Excluded From Medicare, Medicaid

WESTFIELD, NJ — A Westfield OB/GYN, Dr. Labib Riachi, has settled fraudulent billing allegations by agreeing to be excluded from Medicare and Medicaid for 20 years, according to the U.S. Department of Health and Human Services, Office of Inspector General (OIG).

Riachi had 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.

Riachi’s exclusion follows an False Claims Act (FCA) settlement agreement on Feb. 12 with the U.S. Attorney’s Office for the District of New Jersey for false billing for $5.25 million.

In resolving this matter through settlement, Riachi has denied any liability, according to the OIG.

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. He also served as Chair of Obstetrics and Gynecology at Trinitas Regional Medical Center.

He had been awarded in 2015 for performing more than 3,500 surgeries.

Riachi allegedly 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, according to OIG:

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.

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.

“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.”

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