News: Fraudulent doctor reviewed thousands of appeals, denied most, prosecutors say

Former orthopedic surgeon, Spyros Panos, is facing new federal charges for committing healthcare fraud begun while serving a prison sentence for another multi-million dollar healthcare fraud scheme, according to the Department of Justice (DOJ).

Over the past five months, thousands of patients have received notices from several insurance companies that Panos had posed as another doctor in order to review their medical records in coverage disputes, Bloomberg reported. At least 2,500 people nationwide have been affected, but the full reach of the alleged fraud hasn’t been publicized.

Whether Panos’ reviews resulted in claims being denied remains unknown, but the fact that the scheme went undetected for years raises concerns about oversight in the independent medical review industry, according to Bloomberg.

According to the most recent indictment on charges of wire fraud, healthcare fraud, and aggravated identify theft, Panos collected $876,000 since 2013 working on medical and workers’ compensation claims. Prosecutors say that he used a fake Gmail account, a shell company registered in a family member’s name to a Brooklyn, New York address, and another physician’s credentials to accomplish this.

It is not clear whether the patients whose claims were reviewed by Panos will have their cases reopened.

Some of the independent review companies involved have told authorities that they’ve taken steps to prevent unqualified people from posing as reviewers, but they haven’t publicly said how they’ve changed their vetting processes to avert future frauds, Bloomberg reported.

At this time, Panos has plead not guilty.

Editor’s note: To read Bloomberg’s coverage of this story, click here. To read the most recent indictment, click here. To read the statement from the DOJ, click here.