McAllen Urologist and Wife Charged with Health Care Fraud

HOUSTON—A federal grand jury has returned a three-count superseding indictment against Dr. Hossein Lahiji and his wife, attorney Najmeh Vahid Lahiji, both of McAllen and San Antonio, Texas, United States Attorney Kenneth Magidson announced today. The indictment, alleging conspiracy to commit health care fraud and health care fraud, was returned just a short time ago in Houston.

The three-count indictment accuses the Lahijis of conspiring to defraud multiple health care benefit programs, specifically Medicare, Medicaid, Aetna, Blue Cross Blue Shield, Humana, and United Healthcare from January 2003 through February 24, 2012. The indictment alleges they submitted false and fraudulent claims in connection with the use of unlicensed, unqualified medical personal and billed for medical services not rendered.

The Lahijis allegedly submitted claims to these health care benefit programs for urology services performed by Dr. Lahiji when, in fact, he was actually traveling outside the state of Texas and outside the United States. Individuals who actually performed these “urology services,” according to the indictment, were only licensed as medical assistants and did so without any supervision from any physician or other qualified, licensed personal. This is in violation of protocols established by Medicare, Medicaid, private health insurance, as well as the state of Texas.

The scheme also involved specific days where Dr. Lahiji claimed to treat between 65 to 117 patients per day during the office hours of 7:00 a.m. to 6:00 p.m. According to allegations, false and fraudulent representations were made, including that Dr. Lahiji had conducted a “consultation” for another physician when, in fact, he had performed routine medical services for a patient of his own, a practice known as “upcoding.” The indictment further alleges a false representation that the patient’s medical situation had necessitated a comprehensive physical examination and the taking of a comprehensive medical history when the situation had actually not required these actions. Dr. Lahiji did not even perform such an exam nor taken such a history, according to the indictment.

The indictment also contains two substantive counts of health care fraud occurring on July 1, 2009 and July 28, 2009.

Dr. Lahiji is a physican investor in the physican-owned hospital Doctor’s Hospital at Renassiance in Edinburg, Texas, according to public records.

The Lahijis each face a sentence of up to 10 years in prison and a maximum fine of $250,000 on each count, if convicted.

The Lahijis were originally charged in an indictment returned January 11, 2011, in the Southern District of Texas. They are also charged in the District of Oregon on unrelated federal charges. They are currently on bond and are expected to appear in court on these charges in the near future.

The investigation leading to the charges in this case was conducted by the FBI and the Texas Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorneys Carolyn Ferko and Jim McAlister are prosecuting the case.

An indictment is a formal accusation of criminal conduct, not evidence. The defendant is presumed innocent unless and until convicted through due process of law.