(WXMI) — A newly unsealed indictment is detailing 12 counts of healthcare fraud to the tune of $2 million laid out against a local chiropractor.
Ahad Lotfi is accused of defrauding Blue Cross Blue Shield Michigan and the Michigan Education Special Services Association (MESSA), a nonprofit that provides health care to Michigan public school employees.
The indictment claims Lotfi, between the years 2013 and 2017, provided patients with consultations for orthopedic inserts by scanning their feet and relaying the scans to company Foot Levelers, which makes the inserts. Lotfi “encouraged the patients to choose multiple pairs,” according to court documents but also “did not take any medical history from the patients or perform any physical examination of the patients to establish the medical necessity” of the inserts.
When billing insurance, providers like Lotfi at the time would have been required to document the type of service provided, proving it was medically necessary and thus, able to be covered by insurance. This is done through submission of a Form 1500, and procedures have to be "medically necessary" as defined by the American Medical Association’s Current Procedural Coding System.
The indictment claims Lotfi “regularly told his patients that MESSA would pay for multiple pairs of shoes each calendar year” and that he “ordered his staff to call patients each calendar year to remind them and to persuade them to order additional shoes.”
It also shows he “staggered the submission of health care forms” throughout the year to avoid suspicion.
But many of the cases did not meet the criteria of "medically necessary" — Lotfi hadn’t seen many of his patients, in fact. He would scan their feet “without any medical history, physical examination, or even a true doctor-patient relationship.” Oftentimes, the indictment says, he would scan MESSA members right at local high schools.
Between 2013 and 2017, Lotfi submitted health insurance claims to MESSA totaling $1,919,932 and received payment in the amount of $1,001,539.75.
Lotfi had his license revoked by the state in 2018 and has since sold his practices in Paw Paw, Bangor, Hartford and South Haven.
The Better Business Bureau has now opened an investigation and has given him a "no rating" for the time being.
“Be very wary of anyone going door-to-door offering an unsolicited service. If you didn’t seek them out, be wary,” said Katie Grievous, a BBB spokesperson. “You never have to make a decision on the spot. You can take their information, their website, their name, their phone number.”
Lotfi was also charged in 2017 by the attorney general’s office for Medicaid fraud.
