A federal jury on Dec. 16 found a former physician and his company guilty of a scheme to defraud private insurers and the Tricare program by submitting about $355 million in false claims.
Julian Omidi, MD, who had his license revoked in 2009, and Beverly Hills, Calif.-based Surgery Center Management were found guilty of submitting fraudulent claims related to the 1-800-Get-Thin Lap-Band weight loss-surgery business, according to the Justice Department.
Mr. Omidi ran a "Get Thin" network, including Surgery Center Management, that promoted Lap-Band surgeries. He allegedly required prospective patients — even those with insurance plans he knew wouldn't cover lap-band surgery — to participate in at least one sleep study. Prosecutors said that Mr. Omidi used the sleep studies to find the "comorbidity" of obstructive sleep apnea, which the business used to convince insurers to preapprove lap-band surgeries.
Employees allegedly were awarded commissions to ensure the studies happened and often falsified results to support the preauthorization process for Lap-Band surgeries.
If insurers did not authorize the surgery, Get Thin was able to submit bills for about $15,000 for each sleep study and received around $27 million for these claims, the Justice Department found.
The alleged victim healthcare benefit programs included Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund.
Mr. Omidi faces up to 20 years in prison for each of the mail fraud, wire fraud and money laundering counts, as well as a mandatory consecutive two-year sentence for aggravated identity theft.
A sentencing hearing has been scheduled for April 6.