Doc defrauded $1.5M from big insurers, DOJ alleges
A Texas doctor and his attorney wife have been indicted on charges of defrauding more than $1.5 million from private health insurers, as well as Medicare and Medicaid, according to a statement from the Department of Justice last week.
Physician Hossein Lahiji and his wife Najmeh Vahid Lahiji allegedly have been submitting false and fraudulent claims to Aetna, Blue Cross Blue Shield, Humana and UnitedHealth since 2003 for urology services rendered by unlicensed personnel and billing for medical services not provided, the Associated Press reported.
Based on Lahiji's claims, he treated up to 117 patients in a day and sometimes billed for more than 24 hours each day. Lahiji also submitted claims for treatments he provided in his Texas urology clinic while he was traveling abroad. The DOJ said Lahiji billed for chemotherapy injections for prostate cancer, which must be administered under doctor supervision, while he was in Iran, according to Zee News.
Lahiji also allegedly defrauded big insurers by upcoding his claims for a consultation for another physician, when he actually only conducted routine medical procedures for his own patients. The indictment also said that Lahiji sometimes falsely claimed he took some patients' comprehensive medical history when he didn't even perform an exam, reported The Monitor.
CMS fights fraud with predictive modeling
Healthcare fraudsters get stiff sentences
Fraud prevention: Do you know what the criminals are up to?
Anthem investigates Lap-Band centers for fraud
Feds probe Humana on claims, doc loans
Insurers step up efforts to fight fraud