by: Will Conybeare
Posted: Apr 18, 2023 / 03:09 PM PDT
A former doctor from West Hollywood was sentenced to seven years in federal prison for scheming to defraud private insurance companies and the Tricare health care program for U.S. military service members of hundreds of millions of dollars.
Julian Omidi, who ran the 1-800-GET-THIN Lap-Band surgery business, fraudulently submitted nearly $120 million in claims related to his weight loss surgery business, according to the Department of Justice.
Omidi and his Beverly Hills-based company, Surgery Center Management, LLC, were found guilty in December 2021 of 28 counts of wire fraud and three counts of mail fraud. Omidi was also 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, as well as a charge of conspiracy to commit money laundering. Surgery Center Management, LLC, was also sentenced to five years of probation.
The 54-year-old West Hollywood man is a former dermatologist who had his medical license revoked in 2009 after state authorities found he had “engaged in dishonesty and unprofessional conduct related to his application for his California medical license” according to a report released by the Justice Department.
“Mr. Omidi made millions at the expense of the multiple victim companies he defrauded, and he violated his oath to ‘do no harm’ by callously misleading patients about the need for a sleep study and subsequent weight loss surgery,” said Donald Alway, Assistant Director in Charge of the FBI’s Los Angeles Field Office.
According to the DOJ, Omidi established procedures that required prospective Lap-Band patients – even those with insurance plans that he knew would never cover Lap-Band surgery – to have at least one sleep study, and employees were rewarded with commissions to make sure the studies took place. Insurance companies authorized payment for some of the proposed surgeries based on falsified sleep studies and other false information, including patients’ weights.
Omidi used the sleep studies to find a reason – the “co-morbidity” of obstructive sleep apnea – that GET THIN could use to convince the patient’s insurance company to pre-approve the procedure.
Prosecutors estimate that Omidi’s conduct caused insurers, including Tricare, Anthem Blue Cross, UnitedHealthCare, Aetna and others, to spend over $40 million for Lap-Band procedures, sleep studies and CPAP devices and accessories. Even if the insurance company did not authorize the surgery, GET THIN was still able to submit bills for approximately $15,000 for each sleep study, the DOJ said.
“The defendant Julian Omidi deliberately and repeatedly acted with an eye towards business and profits, rather than in the interest of GET THIN’s medical patients by inducing patients to undergo medical treatment premised on fraud rather than medical necessity,” said United States Attorney Martin Estrada. “Including surgeries that carry significant risks and life-long health impacts.”
More than $110 million in funds and securities held by individuals and entities involved in the scheme, including Omidi, were seized by the government in 2014. A money judgment order of forfeiture against Omidi and Surgery Center Management, LLC in the amount of $98,280,221 is being sought by the government. They are pursuing another $107,539,422 in civil forfeiture of seized property.
A separate hearing on restitution and forfeiture in this case, along with the fine for Surgery Center Management, LLC, is expected in the coming weeks.