McAllen Urologist and Wife Charged in Heath Care Fraud Scheme and Conspiracy to Violate Iranian Sanctions

HOUSTON—A federal grand jury has returned a four-count, superseding indictment against urologist Hossein Lahiji M.D. and his wife, attorney Najmeh Vahid Lahiji, both of McAllen and San Antonio, United States Attorney Kenneth Magidson announced today. The second superseding indictment, returned late yesterday, charges the couple with conspiracy to commit health care fraud, health care fraud, and for conspiring to violate Iranian sanctions.

The Lahijis are set to appear in Houston tomorrow morning at 9:45 before U.S. District Judge Mary Milloy.

This indictment alleges the Lahijis conspired to violate Iranian Sanctions by transferring approximately $1.1 million to Iran. The Lahijis allegedly utilized an unlicensed money remitting business called the Espadana Exchange to avoid the United States banking regulations and to allegedly make it appear they were not violating the United States embargo with Iran. The indictment alleges the defendants sent some of the money representing profits of their alleged illegal health care fraud scheme to Iran for the purpose of making an investment on behalf of Hossein Lahiji and Najmeh Vahid Lahiji in real estate rental property in Iran, all in violation of the Iranian sanctions.

“The Internal Revenue Service (IRS) will tenaciously pursue individuals who violate international emergency economic powers statutes,” said IRS-Criminal Investigation (CI) Special Agent in Charge Lucy Cruz. “IRS-CI’s unique skill set is to unravel the often concealed complex networks used to disguise international financial crimes.”

The health care fraud scheme alleged in this indictment accuses Hossein and Najmeh Lahiji of conspiring to defraud multiple health care benefit programs by submitting false and fraudulent claims in connection with the use of unlicensed and unqualified medical personal and for billing for medical services not rendered. The scheme allegedly ran from January 2003 through February 24, 2012, and involved Medicare, Medicaid, Aetna, Blue Cross Blue Shield, Humana, and United Healthcare. The indictment further alleges the Lahijis submitted claims to these health care benefit programs for urology services allegedly performed by Hossein Lahiji M.D. when, in fact, he was traveling outside Texas and outside the United States. The individuals, who were only licensed as medical assistants, were the ones actually performing these “urology services” without any supervision from any physician or other qualified, licensed personal in violation of protocols established by Medicare, Medicaid, private health insurance, and the state of Texas.

The scheme also allegedly involved specific days in which Hossein 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. The indictment further alleges false and fraudulent representations including that Hossein Lahiji had conducted a “consultation” for another physician. In reality, he allegedly performed routine medical services for a patient of his own, a practice known as “upcoding. Lahiji allegedly indicated that the patient’s medical situation had necessitated a comprehensive physical examination and the taking of a comprehensive medical history. However, the patient’s situation had not required such an examination or history-taking, and Hossein Lahiji had not performed such services, according to the indictment.

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

Hossein Lahiji M.D. is a physician investor in the physician-owned hospital Doctor’s Hospital at Renassiance in Edinburg.

The Lahijis each face a sentence of up to 10 years in prison and a maximum $250,000 fine if convicted of the health care offenses as well as a maximum of 20 years in prison and a possible $1 million fine upon conviction of conspiracy to violate Iranian sanctions.

The Lahijis are currently scheduled for a jury trial in Southern District of Texas on March 25, 2013. They are also scheduled for trial in the District of Oregon on June 4, 2013, on unrelated federal charges.

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

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