Two Los Angeles doctors were arrested Wednesday for allegedly taking part in a $250 million bogus billing scheme involving 1-800- GET-THIN Lap-Band surgeries.
Julian Omidi, 49, of West Hollywood, and Mirali Zarrabi, 55, of Beverly Hills, were named in a sprawling 37-count federal indictment alleging mail and wire fraud, false statements, money laundering and aggravated identity theft stemming from GET THIN's Lap-Band -- or bariatric -- surgery and sleep study programs between May 2010 and March 2016, according to the U.S. Attorney's Office.
Zarrabi's attorney, Thomas O'Brien, declined comment. Omidi's lawyer did not immediately return a call for comment.
Two corporations controlled, in part, by Omidi -- Surgery Center Management and Independent Medical Services -- are also named in the updated indictment that was unsealed Wednesday. The Lap-Band is a silicone ring that is surgically implanted around the stomach to discourage overeating.
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"The scheme outlined in the indictment focuses on bogus sleep studies that the defendants utilized to engage in a much more lucrative fraud involving Lap-Band procedures," said acting U.S. Attorney Sandra R. Brown. "Patients were harmed as a result of this fraud scheme when they were subjected to unnecessary medical procedures, and insurance providers were harmed when they paid out tens of millions of dollars after receiving fraudulent bills."
Omidi, a physician whose license was revoked in 2009, controlled, in part, the GET THIN network of companies that focused on the promotion and performance of elective, Lap-Band weight-loss surgeries. Omidi established procedures requiring prospective Lap-Band patients -- even those covered by insurance plans he knew would never cover Lap-Band surgery -- to have at least one sleep study, and employees were offered commissions to make sure the studies occurred, according to the indictment.
The purpose of the sleep studies was to find a second reason -- such as sleep apnea -- that GET THIN would use to convince the patient's insurance company to pre-approve the Lap-Band procedure, federal prosecutors allege.
The U.S. Attorney's Office contends that after patients underwent sleep studies -- often with little indication that any doctor had ever determined the study was medically necessary -- GET THIN employees, allegedly acting at Omidi's direction, falsified the results to reflect that the patient had moderate or severe sleep apnea, and that they suffered from severe daytime sleepiness.
Omidi then caused those falsified sleep study reports to be used in support of GET THIN's pre-authorization requests for Lap-Band surgery, according to the indictment.
Relying on the false sleep studies, as well as other false information, including patients' heights and weights, insurance companies allegedly authorized payment for some of the proposed Lap-Band surgeries. The indictment alleges that GET THIN received at least $38 million for the Lap-Band procedures.
Even if the insurance company did not authorize the surgery, GET THIN still was able to submit bills for $15,000 for each sleep study, according to the indictment. The insurance payments were deposited into bank accounts associated with the GET THIN entities, prosecutors said.
Federal prosecutors said the health care benefit programs allegedly victimized by the billing scam include TriCare, Anthem Blue Cross, UnitedHealthcare, Aetna, Cigna and others.
If convicted as charged, Omidi and Zarrabi could face up to 20 years in prison for each of the 31 mail fraud and wire fraud counts alleged in the indictment alone.
As part of their case, federal prosecutors allege that Zarrabi allowed his electronic signature to be used by GET THIN to make it appear that he had reviewed the falsified sleep studies, even though he knew the reports were being altered, according to the indictment. Zarrabi also allegedly demanded to be paid for the use of his electronic signature on hundreds of prescriptions for devices to treat sleep apnea.
Zarrabi and Omidi "victimized countless patients when they allegedly provided medically unnecessary treatment in order to boost their own profits to the tune of tens of millions of dollars," said California Insurance Commissioner Dave Jones.
"Medical provider fraud is multi-billion dollar problem that drives up health insurance premiums and creates a drain on our economy," he said.