Former surgeon gets 7 years prison, ASC company gets 5 years probation for $355M fraud

A former physician and his ASC company were sentenced to seven years in prison and five years of probation, respectively, for a scheme to defraud private insurers and the Tricare program by submitting about $355 million in false claims related to the 1-800-GET-THIN Lap-Band surgery business.

Julian Omidi, MD, who had his license revoked in 2009, ran a "Get Thin" network that included his Beverly Hills, Calif.-based Surgery Center Management company, the Justice Department said April 18. Mr. Omidi set up procedures requiring prospective patients to have at least one sleep study, even when their insurance plans were known not to cover the surgeries in question.

As part of the scheme, commissions were offered to employees to ensure patients participated in the sleep studies designed to find obstructive sleep apnea comorbidities, the department said. Reports were regularly falsified for preauthorization of the surgical procedures.

Get Thin was able to submit bills for about $15,000 for each sleep study, even when insurers did not authorize the associated surgery, and received around $27 million for these claims, the department said. Mr. Omidi was found to have fraudulently submitted nearly $120 million in claims related to the scheme.

The 1-800-GET-THIN business defrauded payers including Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund.

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