Reading, and understanding, medical billing and records almost requires a medical degree, with the variety of tests, codes, and terms used to define each procedure. Capitalizing on the technicalities of medical billing, some providers have presented fraudulent billing to insurers and the government through Medicare and Medicaid.
According to a report by the Office of the Inspector General, medical fraud, waste and abuse is a leading cause of health care cost increases in the United States. Most of the information concerning this topic involve Medicare and Medicaid but it happens with non-government sponsored insurance as well. Some common issues that cause medical fraud, waste and abuse are “upcoding” or billing for unnecessary procedures, which appears might be the case in this grand jury indictment coming out of California.
Falsifying Medical Reports
On Wednesday, February 28, 2018, a grand jury indicted California doctors Mirali Zarrabi and Julian Omidi for allegedly falsifying medical reports resulting in $250 million worth of fraud to insurers and patients. The indictment also accuses the pair of false statements, wire fraud, mail fraud, money laundering and aggravated identity theft. The doctors garnered much of their business from the now-infamous 1-800-GET-THIN billboards that littered the area.
According to the indictment, patients were subjected to unnecessary medical procedures on account of their behavior. In order to establish that patients needed a Lap-Band installed for weight loss, the doctors would order sleep studies and falsify the severity of patients’ sleep apnea. These falsified reports would then qualify these patients under their insurance companies to obtain authorization to have the Lap-Band surgery performed. A further issue stemmed from the fact that Zarrabi often did not review or interpret the falsified reports; he simply allowed his electronic signature to be used on them.
Now, this is just an indictment, but the Omidi brothers (Michael and Julian) have been the center of various legal battles for years, including a homicide investigation because five patients died after having Lap-Band surgeries at their clinics. Julian Omidi also had his medical license revoked in 2009. The current case, U.S. v. Julian Omidi et al., Case Number 2:17-cr-00661 in the U.S. District Court for the Central District of California, will surely be one to watch as it develops.
If you suspect that a healthcare provider is presenting fraudulent claims to your company, or for more information on medical fraud, please contact the legal team of Parker Straus, LLP.