Because a New York orthopedic surgeon posed as another doctor in order to review medical records in insurance coverage disputes as many as 2,500 people are finding themselves to be fraud victims.
Thousands of Insurance Appeals Went to a Fraud
1 min read Premium comments
Secondary#fraud#insurancefraud
Spyros Panos previously practiced orthopedic medicine as part of a medical group in Dutchess County, New York, and performed orthopedic surgical procedures at hospitals in Poughkeepsie, New York. Panos had performed thousands of surgical procedures and routinely saw at least 60 patients per day. Panos and his medical group submitted false claims about the surgical procedures that he performed, inflating costs and charging for surgeries that he did not perform.
In 2013, Panos pled guilty to a single count of health care fraud in federal court. Panos served time in federal prison and surrendered his license to practice medicine.
After pleading guilty to the fraud but before serving his prison sentence, Panos formed a company called Excel Orthopedics where he claimed that a licensed physician who is an orthopedic surgeon was conducting peer reviews. According to the complaint, the doctor whose credentialing information was submitted to the review companies and represented to be the Excel doctor’s credentials “did not authorize Panos or anyone else to use his/her credentialing information to conduct peer reviews and did not receive any of the review company fees for services he/she was falsely represented to have performed.”
Geoffrey S. Berman, United States Attorney for the Southern District of New York, charged Panos with wire fraud, health care fraud, and aggravated identity theft. The indictment charges Panos with collecting $876,000 from peer review companies through his latest scheme. Panos has pleaded not guilty and is currently in-home detention on $1 million bond.
Over the past five months, thousands of patients have received notices from different insurance companies, notifying them that Panos had posed as another doctor in order to review their medical records for coverage disputes. The full extent of the alleged fraud has not yet been made public, but Bloomberg reports that at least 2,500 people were affected nationwide.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.