This week there was a stunning announcement made by the OIG regarding a New Jersey OB/GYN doctor that agreed to be excluded from participating in any federal healthcare programs such as Medicaid and Medicare for the next 20 years. What makes this exclusion so monumental is that it comes after a hefty settlement by the doctor for $5.25 million dollars that was already settled last winter. There is no precedent of a provider being given both a significant monetary penalty and such a long term exclusion by the OIG.
Chief Counsel to the HHS Inspector General, Gregory E. Demske said that:
“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. In cases such as this, collecting money from a wrongdoer is not sufficient and OIG will pursue exclusion to protect our patients and programs.”
The allegations against Dr. Labib Riachi are that he made thousands of pelvic floor therapy claims that were fraudulent. Interestingly enough Riachi’s license was not revoked as he did not admit to any liability.
All this comes the same a week after the 2017 OIG Work Plan was released which announced that the OIG is conducting investigations that involve organized crime activities, including the growing fraudulent medical schemes that are established for the purpose of being able to steal Medicare dollars. There are investigators that are also finding cases of medical identity theft and it has been said that those who are involved in these schemes could be facing serious jail time and huge fines.
The investigation of Riachi also led to the findings of fraudulent activity practiced by a billing company that was actually helping Riachi with his fraudulent claims. Susan Toy and her company Millennium Billing, became the first actual billing company that has received a penalty by the OIG for the submission of fraudulent claims. Toy had to pay $100,000 and she also agreed to be excluded for five years. This specific allegation demonstrates how much the OIG expects compliance throughout all federal healthcare program processes, and could be a sign of much more thorough investigating of all federal healthcare providers.
It’s also worth noting that if you search for the names of the providers above on the OIG LEIE exclusion list, neither name is showing up on the exclusion list . Just make sure you are using a system that will identify them when they do get added on because you don’t want to be sitting on the other side of this story.