Insurance Company Targets 1-800-GET-THIN - NBC Southern California

Insurance Company Targets 1-800-GET-THIN

Aetna has launched an investigation into alleged fraud against its clients



    Insurance Company Targets 1-800-GET-THIN
    1-800-Get-Thin under scrutiny by federal and local officials

    Insurance giant Aetna has joined distressed families and skeptical federal agencies in pursuing legal action against the marketing firm 1-800-GET-THIN, the company that advertises the lap band weight loss procedure.

    Aetna has launched an investigation into lap band procedures on their clients and is "working with the Southern California Fraud Division of the Department of Insurance to investigate alleged fraud ... by the surgery centers affiliated with 1-800-GET-THIN," the company said in a statement.

    The Department of Insurance's fraud division has several teams looking into alleged insurance fraud, said Byron Tucker, deputy insurance commissioner. The division has the capacity to make arrests and pursue charges against suspects.

    Because the investigation is ongoing, Tucker said he could not comment on specific allegations levied against the companies in question or the scope of the investigation.

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    The marketing company’s president, Robert Silverman, said 1-800-GET-THIN has not engaged in insurance fraud and that his firm has not been contacted by the Department of Insurance, according to an email sent to the Los Angeles Times.

    Charges against the company and its affiliated surgical centers range from false advertising, to racketeering, to covering up patients’ deaths.

    Aetna’s actions add to the pile of litigation against the weight-loss ad campaign by local and federal agencies.

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    At the heart of the issue is the medial procedure that places a band or belt on part of the stomach, tricking the organ so the patient feels full sooner.

    L.A. County supervisors and representatives from the marketing company went head-to-head in Dec. 2011 after the federal Food and Drug Administration charged 1-800-GET-THIN with false advertising.

    Los Angeles County Supervisor Mark Ridley-Thomas called the company’s ambiguity a county-wide health issue.

    "Risky and in some instances, unsafe procedures, do need to be called out," he said during the December hearing.

    If the band is not fitted properly, it can produce heartburn, swelling of the stomach and esophagus, said Dr. Namir Katkhouda, USC professor of surgery. The band can slip so the stomach creates an hourglass shape or it can erode and go inside the stomach.


    "Like every major major surgical procedure, it has to be done technically properly and the patient must be compliant," Katkhouda said.

    A West Hills surgical center connected with the ad campaign was hit with a lawsuit in mid-January, alleging that executives tried to cover up mistakes that led to the Sept. 2011 death of a Lap Band patient at their facility.

    Doctors are accused of ignoring indications that the patient was in distress, claiming that the surgeon stopped the surgery several times because Rojeski was "bucking" on the operating table and alarms on the monitors continued to sound, according to the lawsuit filed in L.A. County Superior Court.

    When medical staff discovered Rojeski did not have a pulse, they called 911 but failed to tell the dispatcher that the patient has been without a pulse for more than 15 minutes.

    The family of a Simi Valley woman filed a medical malpractice/wrongful death lawsuit against Valley Surgical Center and related company Top Surgeons, Inc. Included in the suit is 1-800-GET-THIN LLC.

    According to the lawsuit, the woman’s liver was lacerated during the July 2010 surgery, causing bacteria to enter the abdominal cavity.

    The family said they were never told about the lacerations, but “were led to believe the surgery was a success and without complications,” according to the suit.

    At least five Southern California patients have died since 2009 following lap band procedures at clinics affiliated with 1-800-GET-THIN, but the company cites a state report that ranks their fatality rate lower than that of hospitals that also perform the surgery.

    The Irvine-invented lap band has had a turbulent couple years recently.

    In addition to mounting legal actions, the FDA loosened requirements for surgery approval – opening up the procedure to more than 20 million Americans who previously would have been denied.

    Changes came in Feb. 2011, when the FDA lowered its requirements for body mass index – the ratio between height and weight that gauges a person’s level of obesity – from 40 or 35 with health problems, to 35 or 30 with health problems.

    This means a person 5-foot-11 inches, weighing 215 pounds qualifies for the procedure if they have health problems associated with obesity, such as high blood pressure.

    Just a couple months later, the Lap Band creator Allergan tried to expand the surgery to include teenagers 14 to 17 years old who are morbidly obese.

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    In the long-term, about one-third of all bands have to be removed because they slip, erode or cause swelling, Katkhouda said.