Turlock dermatologist Basil Hantash faces charges of health care fraud after seeking payments from insurers for acne surgeries that were not performed, authorities said.
A federal grand jury returned the eight-count indictment Thursday. Hantash, 44, has been medical director and co-owner of Advanced Skin Institute on Geer Road in Turlock.
According to the indictment, the case involves claims seeking payment for acne surgeries that Hantash submitted to insurance companies between early 2011 and April 2016. An FBI investigation concluded that those patients at Advanced Skin Institute had received only chemical peels, or microdermabrasions, which are cosmetic treatments often not covered by insurers.
The indictment says insurers Anthem Blue Cross and Blue Shield of California paid $220,000 to Advanced Skin Institute for acne surgeries that were not performed.
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An employee said Hantash was seeing patients Friday and referred questions about the federal case to his attorney.
Modesto Attorney Kirk McAllister said the doctor is contesting the charges. “This is a disagreement between the doctor and bean counters at a medical insurance company trying to save money,” McAllister said. “The insurance company has persuaded the government to file these charges.”
In a press release, the Department of Justice said the maximum penalty for the felony charges is 10 years in prison and $2 million in fines.
Prosecutors maintain that chemical peels at the Turlock clinic were primarily done by licensed estheticians, who are not allowed to perform surgeries. The treatments remove outer layers of damaged skin to bring out a healthier-looking appearance.
Insurance companies mostly refuse to pay for chemical peels because they are a cosmetic treatment. Dermatologists are reimbursed, however, for medically necessary acne surgeries, in which a surgical blade is used to cut a lesion and drain fluid.
According to the indictment, Hantash sought $1.2 million in payments on claims for acne surgeries submitted to Anthem Blue Cross during the five-year period. Anthem paid $147,858 on those claims. Blue Shield reimbursed $81,515 for the $645,000 in claims for acne surgeries submitted by Hantash.
The federal government alleges that Hantash and Advanced Skin Institute provided falsified medical records in March 2014 in response to an Anthem Blue Cross audit. “The records falsely claimed that Hantash and (the clinic) had performed acne surgeries on certain patients by using surgical blades. In fact, the patients had only received microdermabrasions or chemical peels,” the indictment says.
If he is convicted, Hantash could forfeit $687,600 that was held in accounts by Vanguard Marketing Corp.
McAllister countered the doctor was involved in a yearlong billing dispute with one insurer and the matter was headed for arbitration. The defense attorney said the practices at Advanced Skin Institute and the billings were appropriate.
A Department of Justice staff member said prosecutors are not commenting further because of the ongoing investigation.
Ken Carlson: 209-578-2321, @KenCarlson16