Tag: 2018 News

Spyros Panos M.D., was an orthopedic surgeon practicing in New York. For years, he seemed like a successful orthopedic surgeon, seeing dozens of patients a day and bringing in millions of dollars in fees for his suburban New York medical group.

Behind the scenes, however, he was inflating charges and billing for surgeries he didn’t perform, perpetrating a years-long fraud that culminated in a guilty plea on a single count in federal court in 2013. In 2013, he surrendered his license to practice medicine following his conviction for health care fraud.

In 2014, Panos began serving a 54-month sentence, and was released in 2016 to a halfway house and then, about a month later, to home confinement. He also faced more than 250 malpractice lawsuits, including some claiming that he botched surgeries.

Since March 2017, he has been serving a two-year term of supervised release. It did not take him long to get into trouble again. But even as he was waiting to be sentenced, federal prosecutors say, Panos was beginning a new criminal scheme that would go undetected for years until he was arrested again in April 2018.

In April 2018, he was charged with wire fraud, health care fraud, and aggravated identity theft, in connection with a scheme in which he assumed the identity of a licensed orthopedic surgeon and obtained over $860,000 in payments for reviewing patient files in Workers Compensation cases.

In about December 2013, after Panos pled guilty on October 31, 2013, and before he surrendered to serve his sentence on April 2, 2014, a company called Excel O LLC was formed. The registered agent for Excel O is a Panos family member and is not a licensed physician. Panos allegedly used this company to hide his identity, and assume the stolen identity of another physician, to dupe utilization review companies who evaluated cases nationwide.

In the latest criminal case, prosecutors say Panos defrauded six utilization review companies for $876,000, using a fake Google email address, a shell company registered in the name of a family member to a Brooklyn address and the credentials of another physician. He is charged with infiltrating an obscure but essential piece of the American health-care business: a $4 billion industry that provides independent doctors to render expert opinions on which treatments are appropriate. He has plead not guilty to the charges.

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. At least 2,500 people nationwide were affected, according to data compiled by Bloomberg, but the full reach of the alleged fraud hasn’t been made public.

Prosecutors did not name the six independent review companies that Panos worked for, but disclosure letters identify some of them: Advanced Medical Reviews and Network Medical Review are both subsidiaries of a company called ExamWorks, which was acquired by the private equity firm Leonard Green & Partners LP for $2 billion in 2016.

At least one company, Gallagher Bassett, a subsidiary of insurance brokerage Arthur J. Gallagher, told California authorities last August, that 1,294 workers’ compensation claims in the state may have been affected through vendors who hired Panos.

Perry Roy Segal M.D., License No. C 39242, is a 1976 graduate of Johns Hopkins University School of Medicine, and is certified by the American Board of Psychiatry and Neurology. He was licensed as a California Physician and Surgeon in June 1980. He is listed as a QME in psychiatry with an office at 250 Blossom Hill Road, in Los Gatos California.

The DWC Disciplined Physicians List shows that his QME certification has been revoked with revocation stayed. He was placed on probation from 10/18/2018 through 10/18/2019 concurrent with Medical Board probation and discipline order..

The Accusation filed against Dr. Segal in July 2015 claimed he engaged in “unprofessional conduct amounting to gross negligence and/or repeated negligent acts and/or incompetence in the care and treatment of Patient T.D.” He had been treating this patient for depression and anxiety, allegedly stemming in part from a possible work-related injury since March, 1999.

On August 6, 2013, the Medical Board received a complaint from a pharmacist, Dr. R. W., at the Fox Army Health Center in Redstone Arsenal, Alabama, regarding Dr. Segal’s prescriptions of pain medication to Patient T.D.

In an interview with the Medical Board, Dr. R. W . detailed that Patient T.D. was receiving prescriptions for Percocet from the Respondent which she filled in Alabama, but that Patient T.D. also filled other pain medication prescriptions in California. Dr. R. W .also reported that it appeared that Respondent, a psychiatrist, was prescribing pain medications and performing pain management without conducting proper physical examinations.

Dr. R. W. reported that she tried repeatedly to discuss the situation with Respondent, who would not contact her. Eventually, Dr. R. W. reached Respondent, who was uncooperative and evasive, telling her that Patient T . D . was a family friend. Ultimately, the Fox Army Health Center refused to fill additional prescriptions for Patient T.D.

Pharmacy and medical records show that during a sample three-year period, Dr. Segal prescribed Patient T.D. various doses and quantities of Demerol, Percocet, Valium, Ambien, Dilaudid, Soma, and Xanax. During this time, Patient T.D. also received pain medications from at least four other doctors.

During his interview with the Board, Segal admitted that he had prescribed pain medications to Patient T.D .for at least a decade, and that he did so as a stop-gap measure to support her during a time when he believed that she had difficulty receiving pain medications from her other health care providers. He stated that he prescribed several dangerous drugs and narcotics to Patient T.D. because she asked for them by name.

During his interview with the Board, Dr. Segal admitted that in the more than ten years of prescribing her pain medication, he had never checked with Patient T. D. s other doctors to ensure that she was not receiving pain medication from multiple providers. He also admitted that he had never checked the Control led Substance Utilization Review and Evaluation System (CURES) to verify her claims that she could not get pain medication from other providers. During his interview with the Board, he admitted that he did not know that CURES existed.

Had he checked CURES or with Patient T. D .’s other health care providers, he would have learned that she was receiving pain medication from at least four other doctors.

In May 2016, Dr. Segal and his attorney signed a Stipulated Settlement with the California Medical Board.

Four chiropractors and a capper were charged this week with insurance fraud in a massive multi-million dollar workers’ compensation insurance referral scheme that exploited persons in predominantly Spanish-speaking communities.

Last year, 10 attorneys and six cappers were charged as part of the same investigation. This is the second phase of filing resulting from a 4-year insurance fraud investigation by the Orange County District Attorney’s Office Bureau of Investigation, Insurance Fraud Unit.

Three defendants charged in Phase I of this investigation have pleaded guilty to participating in the unlawful referral scheme, with one pleading to multiple counts of insurance fraud. In 2014, the OCDA received a tip from a major insurance carrier and initiated an investigation in conjunction with CDI, which ultimately involved more than 20 insurance carriers and self-insured entities conducting business in California.

In 2005, Carlos Arguello III formed Centro Legal Internacional, an “advertising” company, and secured unlawful referral contracts with 20 to 40 workers’ compensation insurance and personal injury attorneys. Arguello required all participating attorneys to sign annual contracts entitled “joint advertising agreement.” Based on the contracts, the attorneys paid Arguello a specified monthly fee for procuring and delivering a minimum number of retained clients per month. Arguello used several names for his referral scheme, including Centro Legal Int’l, Justicia Legal Int’l, and Centro de Abogados Int’l.

He had websites created to advertise these legal services, including iwantmylawyernow.com, instantlawyeraccess.com, centrodeabogadosinternacional.com, uniondeabogadoslatinos.com, and unitedinjuryattorneys.com. Each website and advertisement offered a “free consultation” via an online consultation form or a toll-free number. The toll-free numbers for Centro Legal Int’l, Justicia Legal Int’l, and Centro de Abogados were all directed to a call center in Tijuana, Mexico.

Arguello also owned or was affiliated with other companies that he had the attorneys refer business to, including C & E Technology, Professional Document Management, and Providence Scheduling.

Edgar Gonzalez, another charged defendant in Phase I, is accused of paying attorneys for referral of business to his copy service company, called USA Photocopy, and billing the work to workers’ compensation insurance carriers.

The new Phase II involves Arguello’s call center operators and sign-up agents who were required to stress to the callers the importance of medical treatment to their workers’ compensation or personal injury case, encouraging them to show up to all appointments.

Once the caller agreed to become represented by an attorney from Arguello’s scheme, the “client” was then sold to Providence Scheduling, a service Fermin Iglesias is accused of owning and operating. Iglesias is accused of having arrangements with several chiropractors, including defendants Afsoun Naderi, Bahar Danesh Gharib, Bryan Aun, and John Larson, who are accused of paying Providence Scheduling for patients under the guise of a “Promotion and Scheduling Services Agreement.”

Iglesias is accused of directing these chiropractors to also prescribe durable medical equipment (DME) to their patients through his several DME companies, including Meridian Rehab, Bright Rehab Solutions, Prime Medical Resources, and Prime Orthopedics, all of which he billed to workers’ compensation insurance carriers.

Iglesias is further accused of requiring the chiropractors to refer all diagnostic imaging tests, such as MRI’s, through a scheduling company owned by Iglesias and Arguello called Medex Solutions.

The diagnostic facility owners are accused of paying Iglesias and Medex Solutions kickbacks disguised as “scheduling service” fees for each completed scan. All diagnostic services were billed to workers’ compensation insurance carriers.

While some medical theorists claim cannabis can help you. others might say instead that it hurts you. New research published this month may support the latter theory. Marijuana, it seems, is not a performance-enhancing drug. That is, at least, not among young people, and not when the activity is learning.

A study published in the Journal of Clinical Psychiatry finds that when adolescents stop using marijuana – even for just one week – their verbal learning and memory improve. The study contributes to growing evidence that marijuana use in adolescents is associated with reduced neurocognitive functioning.

More than 14 percent of students in middle school and high school reported using marijuana within the past month, finds a National Institutes of Health survey conducted in 2017. And marijuana use has increased among high-schoolers over the past 10 years, according to the U.S. Department of Health & Human Services.

At the same time, the percentage of teens who believe that regular marijuana use poses a great risk to their health has dropped sharply since the mid-2000s. And legalization of marijuana may play a part in shaping how young people think about the drug. One study noted that after 2012, when marijuana was legalized in Washington state, the number of eighth-graders there that believed marijuana posed risks to their health dropped by 14 percent.

Researchers are particularly concerned with marijuana use among the young because THC, the active ingredient in marijuana, most sharply affects the parts of the brain that develop during adolescence.

“The adolescent brain is undergoing significant neurodevelopment well into the 20s, and the regions that are last to develop are those regions that are most populated by cannabis receptors and are also very critical to cognitive functioning,” says Randi Schuster. Schuster is the director of neuropsychology at Massachusetts General Hospital’s Center for Addiction Medicine and the study’s lead author.

Schuster and the team of researchers set out to determine if cognitive functions that are potentially harmed by marijuana use in adolescents – particularly attention and memory – improve when they abstain from marijuana.

They recruited 88 pot-using teens and young adults, ages 16 to 25, and got some of them to agree to stop consuming marijuana for the month.

The researchers randomly assigned the volunteers into an abstaining group and a nonabstaining group. They delivered the bad news to those chosen to be abstainers at the end of their first visit, and Schuster says, they took it surprisingly well.

Also at each visit, the participants completed a variety of tasks testing their attention and memory through the Cambridge Neuropsychological Test Automated Battery, a validated cognitive assessment tool.

Interestingly, most of the memory improvement for the abstinent group happened during the first week of the study, which leaves the researchers feeling hopeful.

The researchers found that after four weeks, there was no noticeable difference in attention scores between the marijuana users and the nonusers. But, the memory scores of the nonusers improved, whereas the users’ memories mostly stayed the same.

While this study didn’t prove that abstaining from cannabis improves adolescents’ attention, other studies have found that marijuana users fare worse in attention tests than nonusers. Schuster hypothesizes it might take more than four weeks of abstinence for attention levels to improve.

“We were pleasantly surprised to see that at least some of the deficits that we think may be caused by cannabis appear to be reversible, and at least some of them are quickly reversible, which is good news,” Schuster says.

The Los Angeles County District Attorney’s Office reports that a brother and sister who run a construction company in Paramount have been charged with fraud that allegedly resulted in at least $6 million in losses to the State Compensation Insurance Fund and with underpaying employees.

Enrique Vera (dob 2/14/70) of Tarzana, who owns Ultimate, Inc., faces four felony counts of workers’ compensation fraud and three felony counts of grand theft of labor.

Gloria Vera (dob 11/16/60), who is the company’s office manager, is charged with five counts of workers’ compensation fraud, three counts of insurance fraud and three counts of grand theft of labor, all felonies.

The charges include an allegation of fraud and embezzlement that resulted in a loss of more than $500,000 to the SCIF.

Case BA472360 was filed for arrest warrant on Oct. 24. Enrique Vera was arraigned in Department 30 of the Foltz Criminal Justice Center. Gloria Vera will be arraigned at a later time. The prosecutor requested bail be set at $505,000 for Gloria Vera and $430,000 for Enrique Vera.

According to Deputy District Attorney Christopher Hartman of the Healthcare Fraud Division, the siblings allegedly submitted altered payroll records to the SCIF in order to pay a reduced premium on the construction company’s workers’ compensation insurance. They are accused of making false and fraudulent statements with the intent to discourage injured workers from claiming workers’ compensation benefits or pursuing claims.

Gloria Vera also allegedly failed to disclose and concealed employees’ on-the-job injuries that entitled them to workers’ compensation.

The siblings allegedly also underpaid employees the prevailing wage that the company was required to as a contractor for a student housing renovation project at UCLA, the prosecutor said.

Gloria Vera faces a possible maximum penalty of 19 years in state prison if convicted as charged. Enrique Vera faces up to 15 years in prison if convicted.

The case remains under investigation by the District Attorney’s Office’s Bureau of Investigation.