On December 16, 2021, a former lap-band surgeon and his company were found guilty by a federal jury of scheming to defraud private insurance companies and the Tricare health care program for military service members by fraudulently submitting an estimated $355 million in claims related to the 1-800-GET-THIN Lap-Band surgery business.
The United States Department of Justice announced that Julian Omidi, 53, of West Hollywood, California, and his Beverly Hills-based company, Surgery Center Management LLC (SCM), were found guilty of 28 counts of wire fraud and 3 counts of mail fraud. Omidi also was found guilty of two counts of making false statements relating to health care matters, one count of aggravated identity theft, and two counts of money laundering. Omidi and SCM were found guilty of one count of conspiracy to commit money laundering.
During the three-month trial, evidence showed that Omidi, whose medical license was revoked in 2009, controlled, in part, the GET THIN network of entities, including SCM, that focused on the promotion and performance of Lap-Band weight-loss surgeries. Omidi allegedly established procedures requiring prospective Lap-Band patients – even those with insurance plans he knew would never authorize Lap-Band surgery – to have at least one sleep study, and employees allegedly were paid commissions to make sure the studies occurred. Trial evidence showed that Omidi used the sleep studies to find a reason – the “co-morbidity” of obstructive sleep apnea – that GET THIN would use to convince the patient’s insurance company to pre-approve the Lap-Band procedure.
Trial evidence showed that after patients underwent sleep studies, irrespective of whether any doctor had ever determined that a sleep study was medically necessary, GET THIN employees, acting at Omidi’s direction, often falsified the results of the sleep studies. Omidi then used the falsified sleep study results to support GET THIN’s pre-authorization requests for Lap-Band surgery. Relying on the false sleep studies, as well as other false information, including patients’ weights, insurance companies authorized payment for some of the proposed Lap-Band surgeries. GET THIN received an estimated $41 million for the Lap-Band procedures.
Even if the insurance company did not authorize the surgery, GET THIN was able to submit bills for approximately $15,000 for each sleep study, receiving an estimated $27 million in payments for these claims. The insurance payments were deposited into bank accounts associated with the GET THIN entities.
The health care benefit programs billed included Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund, and others. Prosecutors estimated Omidi’s total fraudulent billings at approximately $355 million.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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