Tag: Health insurance fraud

Former Doctor, Julian Omidi, Sentenced To 7 Years

April 18, 2023 ·

WEST HOLLYWOOD—Julian Omidi, 54, a former West Hollywood doctor was sentenced to seven years in prison on Monday, April 17, for submitting $120 million in fraudulent claims related to his 1-800-GET-THIN Lap-Band surgery business. Omidi submitted to private insurance companies and the Tricare Health Care program for U.S Military Service members, the United States Justice Department announced on Tuesday, April 18. 

In December 2021, Omidi and his Beverly Hills based company, Surgery Center Management LLC, were found guilty of 28 counts of wire fraud, three counts of mail fraud and conspiracy to commit money laundering, according to a statement released by the U.S. DOJ. Omidi also was found guilty of two counts of making false statements relating to health care matters, one count of aggravated identity theft and two counts of money laundering. SCM LLC was also sentenced to five years of probation.

Omidi was a former dermatologist who studied at Saint Louis University School of Medicine. He lost his medical license in 2009 after state authorities found that he engaged in “dishonesty and unprofessional misconduct related to his California medical license application,” the U.S. Justice Department’s report stated. 

He oversaw the GET THIN network of entities that focused on the promotion and performance of Lap-Band weight loss surgeries. “Omidi established procedures requiring prospective Lap-Band patients – even those with insurance plans he knew would never cover Lap-Band surgery – to have at least one sleep study, and employees were incentivized with commissions to make sure the studies occurred,” the U.S. DOJ said.  

Omidi used the sleep studies as a way to falsify reasons that a Lap-Band procedure was necessary for his patients. GET THIN employees were instructed by Omini to falsify the results of the sleep studies as well as a patient’s weight. As a result, insurance companies – relying on the sleep study results and other falsified information – pre-approved procedures and authorized payment for Lap-Band surgeries to take place. In a case where insurance companies did not approve the procedure, GET THIN was able to submit bills and receive approximately $15,000 for each sleep study. 

Through this scheme, GET THIN was able to manipulate insurers – Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund and others – to pay out approximately $41 million for Lap-Band procedures, sleep studies, and CPAP devices and accessories. 

“Medical providers are in a position of great trust, and this former doctor broke that trust victimizing patients including military service members with medically unnecessary treatment to boost his own profits by hundreds of millions of dollars,” said Insurance Commissioner Ricardo Lara.

The number of victims that suffered malpractice at the hands of Omini were not disclosed.

In 2014, the government seized more than $110 million in funds and securities from accounts held by Omidi and other individuals and entities involved in the criminal scheme. The government is seeking a money judgment order of forfeiture against Omidi and SCM in the amount of $98,280,221 and is pursuing civil forfeiture of the seized property totaling $107,539,422.

Omidi has a brother, Michael Omidi, who is a plastic surgeon in Beverly Hills.

A separate hearing on restitution and forfeiture, along with SCM’s fine, is expected in the coming weeks.

By Lacy