According to a report by Bloomberg News, more than 2,500 insurance claims by American patients may have been affected by former orthopedic surgeon Spyros Panos, who for several years fraudulently reviewed medical records on behalf of insurance companies. Panos had previously been arrested and charged with health-care fraud in 2013, which cost him his medical license and sent him to prison for 2 years.
The disgraced ex-doctor reportedly stole the identity of a licensed orthopedic surgeon, using the other surgeon’s name and credentials in order to review medical claims without an active medical license. This fraudulent activity may have resulted in wrongfully denied insurance claims. What’s more, insurance companies may have violated the privacy of thousands of claimants whose medical records they sent to Dr. Panos for review.
Such horrifying allegations undermine the reliability of the entire insurance industry, which, for decades has relied on independent medical-expert reviews in order to settle coverage disputes.
What Is Disability Insurance Record Review?
A common practice in the disability insurance industry is to determine whether or not the claimant is disabled based on a review of the medical records by a physician consultant. This practice is highly criticized because the consulting physician has never examined the patient, yet can overrule the opinion of the treating physician. Furthermore, there is a conflict of interest because the consulting physician is employed by the insurance company.
Often, insurance companies hire external physician consultants instead of having their in-house doctors review the medical records. Insurance companies claim these physician consultants are less biased because they are not employees, even though their fees are still paid for by the insurance company. When using an external physician consultant, however, the insurance company remains ultimately responsible for verifying the physician consultants’ credentials and maintaining the privacy of policyholders’ medical records.
For 5 years, Panos was one such independent contractor hired to review denied claims cases. And, according to reports, more than 2,500 people have now been notified by their insurers that their medical reports were reviewed wholly or in-part by Panos.
Details of the allegations are still emerging, and the full extent of Panos’s alleged fraud has yet to be determined. It also remains unclear at this time whether or not all of the medical-record reviews Panos conducted resulted in denied claims, but it has been reported that denial was recommended on most of the claims he reviewed. Panos, who entered a plea of “not guilty,” presently faces charges of wire fraud, health-care fraud, and aggravated identity theft.
Indicted in 2013, Panos Is No Stranger to Fraudulent Behaviors
It was only 5 years ago that Spyros Panos had his medical license revoked. Prior to that, he worked for a Poughkeepsie, New York medical group, running what seemed to be a very successful orthopedic surgical practice.
The success, however, was an illusion. In reality, then-doctor Panos had been inflating charges and falsifying billing information in order to rake in millions of dollars for surgeries he didn’t actually perform. According to court records, Panos made more than $7.5 million from inflated or false charges. The records detail highly suspicious figures in which Panos claimed he performed 20 surgeries a day in addition to seeing between 60-90 patients per day.
At the time, Panos also faced more than 250 medical malpractice lawsuits – several of which claimed the doctor had made mistakes during surgery. He pleaded guilty in 2013 to a single count of health-care fraud and, in April 2014, Panos went to prison for 2 years.
Among the latest allegations, Panos is charged with defrauding 6 medical-insurance review companies using the active medical credentials of another licensed physician, made-up Gmail accounts, and a shell company registered under the name of a family member. According to federal investigators, Panos made $876,000 through these fraudulent activities.
The New York inspector general, Catherine Leahy Scott, spoke of the allegations against Panos in a recent statement:
“With jaw-dropping hubris, this disgraced former physician engaged in a health-care fraud scheme while serving a federal sentence for yet another health-care fraud. The alleged actions behind these new charges demonstrate his apparent lack of remorse and a clear disdain for making an honest living."
What about the 2,500 Claims Panos Reviewed?
Given the fact that Panos denied most of the insurance claims that came under his review, many patients should have their cases reopened and reviewed once again – legitimately.
Sokolove Law believes re-opening cases should be the insurance companies’ obligation to patients. If a convicted felon and someone who is presently facing charges of fraud and identity theft has permanently altered someone’s life by denying their insurance claim, at the very least the case deserves to be re-opened and re-reviewed.
Oversight and Greed, the Bottom Line
Panos’s alleged infiltration of the insurance industry’s medical-review process raises huge red flags as to the lack of oversight in an area of healthcare upon which hard-working Americans rely. It should go without saying that such oversights cannot be tolerated.
Some of the insurance companies involved in the current allegations, having indirectly contracted Panos’s services are: Anthem Inc., Health Care Service Corp., and The Hartford. These insurers have notified their patients and are revisiting the specific cases Panos may have impacted. Other insurance companies involved, however, have not offered such reassurance, instead only warning patients that their privacy may have been violated.
In the meantime, there is no telling just how many people with injuries, disabilities, or life-altering diseases and disorders have been irreversibly affected by Spyros Panos’s actions. Those who have been notified by their insurance company of a data security or privacy breach may be eligible for compensation and should contact Sokolove Law right away for a free legal consultation. Insurance companies want to increase their bottom line by denying or delaying claims whenever possible. Sokolove Law can look out your best interests and help get you the money you may deserve for your injuries.