WILL A 20-YEAR EXCLUSION HELP DETER HEALTH-CARE FRAUD?

 

It’s no secret that Medicare and Medicaid patients are crucial to the bottom line for many physicians. So being excluded from participating in the programs is a big deal and can sometimes mean the end of a medical practice.

A recent 20-year exclusion issued by the HHS Office of Inspector General should serve as a cautionary tale for physicians and proof that the government is keeping close eye on physician conduct. Labib Riachi, a New Jersey-based OB/GYN, was excluded for allegedly submitting thousands of fraudulent claims for pelvic floor therapy.

David Blank, a senior counsel with the OIG who represented the agency in the Riachi investigation, told me the exclusion was one of the longest reached under the OIG’s permissive exclusion authority and the longest issued after an agency-initiated legal action.

Riachi reached a $5.25 million False Claims Act settlement in February over the false claims, and Blank told me the OIG thought the settlement didn’t go far enough based on Riachi’s alleged actions. The OIG set out to determine if Riachi required a corporate integrity agreement or exclusion, and Blank said it became readily apparent that exclusion was necessary.

In addition to the monetary loss Riachi caused to Medicare and Medicaid, the OIG determined his alleged actions carried a significant risk of patient harm, Blank said. For example, Blank said Riachi allegedly provided electrical stimulus to patients with pacemakers and allowed unlicensed and unqualified staff to perform procedures.

An initial notice of proposed exclusion called for a 30-year exclusion for Riachi, but he ended up settling on a 20-year period rather than going before an administrative law judge, Blank said. While he agreed to the exclusion, Riachi denied any liability.

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