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Physician Agrees to $1.5 Million Payment and 15-Year Exclusion To Settle Civil Monetary Penalty Case

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Washington, DC -- Joseph A. Raia, M.D., agreed to resolve his liability for submitting false and fraudulent Medicare claims, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services is announcing today. Dr. Raia will pay $1.5 million in assessments and penalties and be excluded from participation in all Federal health care programs for at least 15 years under the terms of the agreement.

OIG alleged that between January 2006 and November 2011, Dr. Raia submitted, or caused to be submitted, thousands of claims for physical therapy and related physical medicine and rehabilitation services to Medicare for services that were never provided or were otherwise false or fraudulent.

Dr. Raia, a physiatrist licensed in New Jersey and New York, was the owner and chief operating officer of Grafton Medical Center, PC, and Joseph A. Raia, M.D., P.C., physical medicine and rehabilitation practices located in Newark and Brooklyn. Dr. Raia was also an employee of a physician group practice with multiple locations in Brooklyn.

OIG had initiated an administrative case alleging the following conduct. Dr. Raia submitted claims to Medicare for the provision or supervision of physical therapy and related services for which he was not in the State where the services were allegedly performed. Dr. Raia submitted claims for physical therapy and related services simultaneously rendered in five different locations in two States.

Additionally, OIG alleged that Dr. Raia had improperly used chiropractors to provide physical therapy services "incident to" his professional services. OIG alleged further that Dr. Raia had routinely submitted claims for time-based procedures that exceeded 24 hours in one day.

"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. "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."

Under the Civil Monetary Penalties Law (CMPL), OIG may seek civil money penalties, assessments, and exclusion for causing the submission of false or fraudulent claims to Federal health care programs. The CMPL is designed to deter persons from defrauding Federal health care programs, to compensate those programs for damages resulting from such fraud, and to protect the integrity of these programs.

Mr. Demske credited special agents from OIG's Office of Investigations, New York Regional Office, under the direction of Special Agent in Charge Tom O'Donnell, with conducting the investigation leading to the settlement of this matter.

OIG was represented in the investigation and litigation of this matter by the following legal staff: David M. Blank, Tamara T. Forys, Lauren E. Marziani, and Karen Glassman, with assistance from Mariel Filtz.

In resolving this matter through settlement, Dr. Raia has denied any liability. No judgment or finding of liability has been made against Dr. Raia.