Stepping On The Scale

Medicare enrollment form and glasses

The 1-800-GET-THIN billboards once dominated the Los Angeles landscape with claims of a one-hour procedure and an easy insurance verification process. Too good to be true? Yes, it was. Because, after Dr. Julian Omidi submitted nearly $120 million in fraudulent claims for Lap-Band surgery the only thing that got “thin” was the U.S. taxpayers’ pockets.

Dr. Julian Omidi controlled several entities in the GET-THIN network. He incentivized employees to “ensure” patients underwent sleep studies. After patients underwent sleep studies, irrespective of whether the study was determined to be medically necessary , Omidi’s falsified the results. Relying on the false sleep studies – as well as other false information like patients’ weights (is it not bad enough stepping on the scale? The doctor needs to increase the number?), insurance companies authorized payment for these proposed Lap-Band surgeries.

The 1-800-GET-THIN business received approximately $41 million for those procedures. While not all patients were approved to receive the surgery, prosecutors say GET-THIN would always bill the patient roughly $15,000 for each sleep study, totaling $27 million in payments from insurance providers.

Patient care was not ever in the forefront of Omidi’s practice. Omidi’s medical license as a dermatologist was revoked in 2009 after state authorities found he had engaged in dishonest and unprofessional conduct. From 2010 to 2014 five patients died after they received Lap-Band surgeries at clinics affiliated with 1-800-GET-THIN. And in a 2009 inspection, the Department of Health and Human Services found unsanitary conditions, inoperative scrub sinks, one-time-only equipment being reused and several other deficiencies. The inspector shut down the clinic for a day, but further action was obviously not taken since Omidi continued in his schemes for nine more years.

Omidi’s scheme was wide ranging in scope, targeting Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund. Omidi was sentenced to seven years in prison.

Shout out to the U.S. Food and Drug Administration Office of Criminal Investigations who stopped this fraud by Omidi.

Today’s Fraud Of The Day is based on article “Former physician gets 7 years for $120M fraud scheme” published by Beckers Hospital Review on April 18th, 2023

A former dermatologist was sentenced to seven years in prison for fraudulently submitting nearly $120 million in claims related to the 1-800-GET-THIN Lap-Band surgery business.

Julian Omidi, 54, of West Hollywood, Calif., submitted fraudulent claims to private health insurance companies and Tricare, according to an April 18 Justice Department news release.  Mr. Omidi controlled, in part, the Get Thin network of entities that focused on the promotion and performance of Lap-Band weight-loss surgeries, according to the release.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.