Julian Omidi, a former doctor from West Hollywood, has been sentenced to 84 months in federal prison for participating in a scheme to defraud private insurance companies and the Tricare health care program for U.S. military service members. He was found guilty of submitting nearly $120 million in fraudulent claims related to the 1-800-GET-THIN Lap-Band surgery business. Omidi was also found guilty of wire fraud, mail fraud, making false statements related to health care matters, aggravated identity theft, money laundering, and conspiracy to commit money laundering.
Omidi controlled the GET THIN network of entities, including Surgery Center Management LLC (SCM), a Beverly Hills-based company. SCM was sentenced to five years’ probation, and a separate hearing on restitution and forfeiture, along with SCM’s fine, is expected in the coming weeks.
Prosecutors estimate that Omidi’s conduct caused insurers and Tricare to pay at least approximately $41 million for Lap-Band procedures, sleep studies, and CPAP devices and accessories tainted by this fraud. The victim health care benefit programs include Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund, and others.
Omidi’s medical license was revoked in 2009 after state authorities found he had engaged in dishonesty and unprofessional conduct related to his application for his California medical license. He established procedures requiring prospective Lap-Band patients to have at least one sleep study, even those with insurance plans he knew would never cover Lap-Band surgery, and employees were incentivized with commissions to make sure the studies occurred.
After patients underwent sleep studies, GET THIN employees, acting at Omidi’s direction, often falsified the results. Omidi then used the falsified sleep study results in support of GET THIN’s pre-authorization requests for Lap-Band surgery. Relying on the false sleep studies, insurance companies authorized payment for some of the proposed Lap-Band surgeries.
In 2014, the government seized more than $110 million in funds and securities from accounts held by individuals and entities involved in the criminal scheme, including Omidi. The government is seeking a money judgment order of forfeiture against defendants Omidi and SCM in the amount of $98,280,221 and is pursuing civil forfeiture of the seized property totaling $107,539,422.
The U.S. Food and Drug Administration Office of Criminal Investigations; the FBI; the Defense Criminal Investigative Service; IRS Criminal Investigation; and the California Department of Insurance investigated this matter.
A hefty penalty/money judgment.