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Physician to pay $1.5 million in Medicare fraud settlement

By Nicole Freeman

Joseph A. Raia, MD, has agreed to at least 15 years exclusion from all federal healthcare programs and pay $1.5 million in penalties and assessments to settle his liability in a Medicare fraud case, according to the Office of Inspector General (OIG) Raia was charged with submitting false and fraudulent claims to Medicare for physical therapy-related services that were not provided, but has denied any liability.

The fraudulent claims were submitted between January 2006 and November 2011, billing Medicare for physical therapy and rehabilitation therapy services. At the time, Raia was part of a physician group operating at multiple locations in Brooklyn, as well as the owner and operator of Grafton Medical Center, PC, and Joseph A. Raia, MD, PC, in Newark and Brooklyn.

Raia was charged with submitting claims to Medicare for services he allegedly provided while not in the state where the services were performed, submitting claims for services that were provided simultaneously at five locations in two states, and submitting claims for time-based procedures that added up to more than 24 hours in a single day.

OIG may seek assessments, civil money penalties, and exclusion resulting from false federal healthcare program claims under the Civil Monetary Penalties Law (CMPL), which is intended to discourage submitting false claims and reclaim money stemming from these Federal reimbursements.

“This settlement and its significant period of exclusion send a strong message that physicians who defraud Federal health care programs face significant consequences,” said Gregory E. Demske, Chief Counsel to the HHS Inspector General, in a public statement. “OIG is committed to using our administrative enforcement tools to take action against physicians who are stealing from taxpayers by falsely billing the Medicare program.”




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