California physician found guilty in $355M billing fraud scheme

A California physician was found guilty by a federal jury Dec. 16 of scheming to defraud health insurers by submitting fraudulent claims, according to the Justice Department.

Julian Omidi, MD, whose medical license was revoked in 2009, was found guilty of wire fraud, mail fraud, making false statements relating to healthcare matters, aggravated identity theft, money laundering and conspiracy to commit money laundering.

According to prosecutors, Mr. Omidi falsified sleep studies to make it appear patients suffered from sleep apnea, which would help convince insurance companies to pre-approve lap-band procedures performed at facilities he controlled.

Relying on false information, including the sleep studies, insurance companies paid Mr. Omidi’s network of facilities an estimated $41 million for the lap-band procedures. When the insurance companies didn’t authorize the surgeries, employees at the facilities submitted bills for $15,000 for each sleep study. The facilities received an estimated $27 million for these claims, according to the Justice Department.

As part of the scheme, Mr. Omidi submitted $355 million in fraudulent claims to Tricare and several private insurers, including Anthem Blue Cross, UnitedHealthcare and Aetna.

Mr. Omidi is slated to be sentenced in April.

Source: California physician found guilty in $355M billing fraud scheme / Becker’s Hospital Review

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