800-GET-THIN surgery centers sue insurer over Lap-Band payments

Ten Southern California surgery centers once affiliated with the defunct 1-800-GET-THIN advertising campaign are suing UnitedHealth Group Inc. to get reimbursed for hundreds of Lap-Band weight-loss procedures.

The lawsuit comes amid federal and state investigations into allegations that the surgery centers defrauded UnitedHealth Group and other insurance companies, according to a government affidavit and a demand letter filed in two federal court cases.

The 1-800-GET-THIN ads once blanketed Southern California freeway billboards and broadcast airwaves, but the campaign was halted after the Food and Drug Administration said the ads failed to disclose adequately the risks of weight-loss surgery.

Five patients died after Lap-Band surgeries at clinics affiliated with the 1-800-GET-THIN campaign, according to lawsuits, autopsy reports and other public records. The Lap-Band is a silicone ring that is surgically implanted around the stomach and tightened to discourage overeating.

In the latest lawsuit, filed March 21 in Los Angeles County Superior Court, the surgery centers alleged that UnitedHealth authorized the Lap-Band surgeries, then refused to pay for them.

"If they didn't want my clients to provide the services they shouldn't have authorized it," said the plaintiffs' attorney, Daron Tooch. "United is using the excuse of the investigation not to pay."

UnitedHealth said: "We are currently reviewing the complaint … and will determine the appropriate legal response to this lawsuit. This same law firm attempted to take similar legal action against us on behalf of several [Lap-Band] patients, and those suits were all dismissed by the court."

In a lawsuit over Lap-Band reimbursements last year, UnitedHealth filed documents that said it had been notified by the California Department of Insurance that the agency was investigating possible insurance fraud on the company by 1-800-GET-THIN and the affiliated companies.

The insurance department issued a letter demanding all surgery bills UnitedHealth had received from 1-800-GET-THIN and the clinics, according to documents filed in that lawsuit.

In 2012, a federal Food and Drug Administration investigator said in a court filing in an unrelated criminal case that several federal law enforcement agencies were investigating 1-800-GET-THIN and the affiliates for possible violations of federal law.

Officials with the state insurance department and the Justice Department declined this week to discuss those investigations.

John Hueston, an attorney for brothers Michael and Julian Omidi, who have been identified in court documents as the surgery centers' owners, did not respond to requests from The Times for an update on the criminal investigations.

The surgery centers' lawsuit does not specify the amount of money UnitedHealth owes, but Tooch said it was "hundreds of millions of dollars." He also said UnitedHealth was the first of several insurance companies his clients intend to sue for failing to pay for Lap-Band procedures.

Kathryn Trepinski, a Beverly Hills attorney for relatives of a woman who died after Lap-Band surgery at a clinic affiliated with 1-800-GET-THIN, said it is highly unusual for the subject of a criminal investigation to sue in these circumstances.

"Why would they file a lawsuit against a major insurance company at the same time the surgery centers seem to be under investigation by the California Department of Insurance?" Trepinski said. "What is the wisdom of that?"

Allergan Inc., which made the Lap-Band until it sold the brand last year, said the surgeries typically cost $12,000 to $20,000. UnitedHealth, defending itself in a civil case last year, alleged that one of its insured clients was charged more than $280,000 for Lap-Band surgery and other procedures. The insurer won dismissal of the case.

UnitedHealth asserted in the same case that medical reports that surgery centers submitted to it listed conflicting height and weight for a weight-loss surgery patient.

One report said the woman was 5-foot-3 and 200 pounds, a ratio that would have qualified her for insurance-covered Lap-Band surgery under her health plan. A second report, filed by an anesthesiologist, said the woman was 5-foot-5 and 203 pounds, which would have made her ineligible for coverage.

"The weight of an adult woman may fluctuate, but her height does not," UnitedHealth said in the filing.

Plaintiffs in the surgery centers' lawsuit are Almont Ambulatory Surgery Center; Bakersfield Surgery Institute; Independent Medical Services Inc.; Modern Institute of Plastic Surgery & Antiaging Inc.; New Life Surgery Center; Orange Grove Surgery Center; San Diego Ambulatory Surgery Center; Skin Cancer & Reconstructive Surgery Specialists of Beverly Hills Inc.; Valencia Ambulatory Surgery Center; and West Hills Surgery Center.




Copyright © 2019, Los Angeles Times
EDITION: California | U.S. & World