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Entries in Fraud (9)

Friday
Jul192013

Surgeon Accused of Fake Surgeries

Courtesy Debra Nenni McNamee(POUGHKEEPSIE, N.Y.) -- Constance Nenni died after having a "phantom" knee surgery, according to a legal complaint filed against her orthopedic surgeon, Dr. Spyros Panos.

In March 2010, Nenni underwent surgery to repair a left knee that had grown arthritic from 76 years of wear and tear, her daughter Debra Nenni McNamee said. She died less than 24 hours after having surgery.

McNamee said she recalled Panos explaining the procedure as "a simple in and out." He asked her mother sign a consent form to have a scope with a camera surgically inserted in her knee and to remove any dead or damaged tissue he found. Then, McNamee said she sat for two hours in the waiting room of the Hudson Valley Center at Saint Francis Hospital in Poughkeepsie, N.Y., waiting for her mother to come out of surgery.

"Afterwards, a nurse came out and said that my mother's blood pressure had dropped so they had to put her under a heating blanket for a while, but she didn't seem concerned so I relaxed," she said.

Less than 24 hours later, Nenni collapsed and died at home on the bathroom floor of a pulmonary embolism, according to a medical examiner's report.

A pulmonary embolism is a dangerous side effect of surgery where a blood clot breaks free and blocks the lung's main artery. Older people are especially vulnerable to this risk. Although McNamee didn't know it at the time, she said doctors later told her that a spike in blood pressure can be a warning sign that the condition is developing.

But Brian Brown, McNamee's lawyer, said the medical examiner's report also revealed some shocking news: Panos never performed a single procedure on Nenni.

Despite writing post-operative notes stating that he had performed six procedures on Nenni, including the removal of torn cartilage, smoothing areas of arthritic wear and removal of soft tissue from within the knee joint, the autopsy and hospital records revealed Panos did none of those things.

"He put her under anesthesia, placed the scope in her knee and then closed her up without performing any surgery," Brown said. "The reports showed no hardware in place and, certainly, no evidence of a total knee reconstruction."

If true, it didn't appear to be an isolated incident. There have been at least 250 legal actions filed against Panos in state Supreme Court of Dutchess County, N.Y., noted JT Wisell, an attorney for 154 of the plaintiffs.

Panos is also the subject of a criminal investigation by the U.S. Attorney's Office, though he has not been charged with a criminal offense, Wisell said.

Wisell said that most of the pending legal cases against Panos fall into three broad categories: fraudulent surgeries like Nenni's, unnecessary or excessive procedures, and medical negligence.

Jeffery Feldman, Panos' attorney, said that it would be unethical to speak about matters currently under litigation and that he had no comment. He added that Panos could not be reached for comment.

The Mid Hudson Medical Group is named as a defendant in many of the legal cases against Panos. So, too, are the hospitals where he performed surgery, Saint Francis Hospital and Vassar Medical center, both located in Poughkeepsie, N.Y.

Lawyers for the Mid Hudson Medical Group and Vassar Medical Center declined to comment. Larry Hughes, a spokesman for Saint Francis Hospital said the hospital also declined to comment.

Another lawsuit against Panos describes how he performed rotator cuff surgery on a patient's shoulder even though her X-ray was clean, yet he ignored a severely fractured collarbone, Wisell said.

Numerous plaintiffs claim Panos didn't cement joint replacements together properly or used the wrong components to repair a joint, Wisell added.

Brown said that Panos used his patients like human cash registers, scheduling as many as 22 surgeries a day. The average orthopedic surgeon typically schedules no more than 32 procedures a month, according to American Academy of Orthopaedic Surgeons statistics.

McNamee said the bills for her mother's care were more than $50,000. She also received a bill from Mid Hudson for her mother's post-operative follow up -- more than two years after her mother had passed away.

"We lost her because someone was looking to make money on her," McNamee said. "He took an oath to care for people not to kill people and cover it up."

Wisell, who referred to Panos as "The Hudson Valley Hack," agreed that Panos was after money. He also said he is certain other medical professionals knew Panos was scheduling too many surgeries and should have spoken up.

"I'm a million percent sure that the proper safeguards were put in place but they were completely ignored," Wisell said. "His employers and colleagues had to know what he was doing but there was too much money at stake so they looked the other way."

Both Brown and Wisell noted that clients with potential cases against Panos began flooding their offices with calls immediately after journalist Sarah Bradshaw wrote about the first few lawsuits for the Poughkeepsie Journal in September 2010. Bradshaw said she was tipped off to the litigation from an anonymous source.

Panos was terminated from his employer, Mid Hudson Medical Group, in 2011, Brown said.

Panos is currently licensed to practice in New York State and the New York State Office of Medical Conduct does not list him in its database of professional misconduct and physician discipline. The Medical Conduct Office did not immediately have an answer for why Panos was not in its system.

Panos appeared to be blogging and maintaining active Facebook page and Twitter accounts until at least July 2012.

In one blog post, he wrote that a patient once referred to him as a "21st century Marcus Welby," and that he is, "in fact, humanizing medical care and treatment." In another post, he stressed the importance of pre-operative care for better patient outcomes.

Copyright 2013 ABC News Radio   

Thursday
Mar012012

Undercover Grandma Catches Medicare Fraud on Tape

ABC News(MCALLEN, Texas) -- In the wake of an ABC News undercover investigation, federal authorities in Texas are investigating how an active 82-year-old grandmother was diagnosed as homebound, with a range of ailments that she did not have, including Type 2 diabetes, opening the door to potentially tens of thousands of dollars in Medicare payments for home health care, supplies and equipment she did not need.

A hidden camera recorded the undercover grandmother's visit to a doctor in McAllen, Texas, where she told the doctor and nurses she exercised regularly and, other than some hypertension and arthritis, was in excellent health.

"I've really enjoyed good health all my life, God's been good to me," the doctor was told by Doris Ace, the grandmother of ABC News producer Megan Chuchmach.

Yet the official certification sent to Medicare for home health care services indicates she was homebound and suffered from two internal infections, incontinence and needs "assistance in all activities, unable to safely leave home, severe sob" -- an abbreviation for shortness of breath.

Ace had specifically told the doctor and her nurses she did not suffer from incontinence or shortness of breath.

On a patient referral form for home health care service, signed by the doctor, our undercover grandmother was also wrongly diagnosed with type 2 diabetes, even though she was not given a blood test which doctors say is the only way to authoritatively diagnose diabetes.

The overall diagnosis of the undercover grandmother's health could have provided the justification for what could be tens of thousand dollars a year worth of unneeded treatment and medical supplies and equipment, federal investigators said in an interview to be broadcast Thursday night on ABC News' World News with Diane Sawyer and Nightline.

"That's fraud," said Tim Menke, senior adviser for investigations in the Inspector General's office at the Department of Health and Human Services.

"Our Medicare system is an honor system," said Menke after viewing the files and the ABC News undercover tape of the doctor's office visit.  "And there's not much honor left in the system when you see things like that."

McAllen is considered a hotbed of Medicare fraud by the Inspector General's office, which has already brought cases against a number of doctors and health care agencies and has many others under investigation.

"The fraud indicators are off the charts," said Menke of McAllen and surrounding towns in the Rio Grande Valley.  "We have ten of the top physicians who have billed nearly $200 million in one specialty last year alone."

Nationwide, the Inspector General's office estimates that $60 billion dollars of taxpayer money is lost to unchecked Medicare fraud every year.

"We've seen it in Miami, Detroit and now in McAllen and it's very, very common," he said.

"They're lying in order to steal from you and me and the taxpayers," he added.

The McAllen doctor, Dr. Padmini Bhadriraju, declined to comment to ABC News, but denied any wrongdoing through her lawyer.

The lawyer, John Rivas, said the doctor acknowledged an "error" in the diabetes diagnosis for ABC News' undercover grandmother on the patient referral form, but said, "this section was filled out by someone other than Dr. Bhadriraju," even though he confirmed the doctor did fill out the majority of the form and signed it in her handwriting.

Her signature served as certification that "my clinical findings support that this patient is homebound."

The doctor's lawyer said neither the doctor nor others in her office knew who filled in the incorrect diabetes diagnosis.

Rivas also said the doctor played no role in the official certification form sent to Medicare, although records show she billed Medicare for the review of the form and its plan of care.

"The records provided by ABC News do not support any allegations of fraud.  It would be irresponsible journalism to air a story on Medicare/Medicaid fraud using this referral as an example when there is clearly no evidence of fraud," he added in a letter to ABC News.

ABC News ended the undercover investigation before any medical supplies or equipment could be billed to Medicare based on the false diagnosis. 

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Copyright 2012 ABC News Radio

Tuesday
Oct252011

Investigation Uncovers Rampant Fish Fraud

Jupiterimages/Thinkstock(BOSTON) -- A new investigation provides fresh evidence that restaurants and markets continue to dupe seafood lovers into paying top dollar for low-grade fish.

As part of a special “Fishy Business” series, the Boston Globe spent five months buying fish from dozens of establishments throughout Massachusetts and sending the samples off to a lab in Canada. DNA tests found 48 percent of the fish had been mislabeled as a more expensive type of fish.

Fish samples were gathered from 134 restaurants, grocery stores and seafood markets, and the results were staggering.  Every one of 23 white tuna samples tested turned out to be something other than tuna. In most cases the fish labeled tuna was escolar, which the Globe said was “nicknamed 'the Ex-Lax of fish' by some in the industry for the digestion problems it can cause.”

All but two of the 26 red snapper samples were another kind of fish, the Globe reported. That came as no surprise to Cape Cod fisherman Eric Hesse, who was quoted in the report.

“Mislabeling fish is at a ridiculous level,” said Hesse. “The dealers and restaurants have a vested interest in keeping the illusion going. Every time they can say they are selling fresh, local fish and get away with selling [Pacific] frozen, they don’t have to buy it from us. It kills us.”

The problem extends far beyond Boston and affects consumers nationwide. Earlier this year, ABC News correspondent Elisabeth Leamy reported that seafood may be mislabeled as often as 70 percent of the time.

“According to Food and Drug Administration port inspections,” Leamy said. “A third of seafood sold in the U.S. is mislabeled as one type when it’s actually something else, even something cheaper.”

The environmental group Oceana said part of the problem is the FDA’s lax enforcement of laws that make it a crime to mislabel seafood.

FDA officials acknowledged they could do more to police against fish fraud. The agency has nine new seafood testing machines and is training inspectors in how to use them. Field testing is expected to begin early next year.

For now, not all the Globe’s results were so disheartening: some of this country's largest retailers were selling the real McCoy -- or mackerel: every sample tested from Walmart, Trader Joes, and BJ’s Wholesale was correctly labeled, as was every sample of mahi mahi and swordfish.

Copyright 2011 ABC News Radio

Thursday
Oct202011

‘Adult Baby’ Cleared of Fraud, Still Getting Social Security Checks

Comstock/Thinkstock(LOS ANGELES) -- The California man who lives his life as an “adult baby,” complete with adult diapers, bottles, a crib and a mother-figure caregiver, says he has been cleared from suspicion of Social Security fraud and will continue to receive his disability checks.

Stanley Thornton, Jr. has a condition called paraphilic infantilism that involves role-playing as an infant. Though paraphilic infantilism is a sexual fetish for some, Thornton explains on his website that he pretends to be a baby because it makes him feel “safe” and helps him cope with the post traumatic stress he suffers from physical and sexual abuse he suffered as a child.

After Thornton’s lifestyle was showcased on National Geographic’s television show Taboo, Sen.  Tom Coburn, R-Okla., accused him of defrauding Social Security because the episode shows him exhibiting work skills such as building a high chair and operating his website.

John Hart, a spokesman for Coburn, told the Washington Times that the senator, also a doctor, questioned how “a grown man who is able to design and build adult-sized baby furniture is eligible for disability benefits.”

Faced with the possibility of losing his source of income, Thornton threatened suicide when questioned on the matter by the Times.

In August, however, Thornton reported on his website that his disability had been cleared and the Social Security administration confirmed that his disabilities are “continuing.” He will continue to receive the $860 monthly checks from the agency that he lives on.

In the same post on his website, Thornton defends his reasons for being on disability.

“I am not getting disability because I am a Adult Baby. No one can get on disability because they are a Adult Baby. I am on disability for legit, tested and well documented illnesses [such as] PTSD (Post Traumatic Stress Disorder), ADHD (Attention Deficit Hyperactivity Disorder), depression, bipolar 2, spinal injury, heart problems...my role playing is a way for me to relax, not a disability that is being claimed for a disability.”

Copyright 2011 ABC News Radio

Thursday
Sep082011

Medicare Fraud Bust Nets 91 People, Including Doctors and Nurses

PhotoAlto/Frederic Cirou/Thinkstock(WASHINGTON) -- The Justice Department announced on Wednesday that 91 people allegedly scammed $295 million from Medicare by falsely billing the entitlement program.

To make matters worse, some of the suspected crooks are doctors, nurses and other medical professionals, according to Attorney General Eric Holder.

In announcing the charges, Holder said they were "based on a variety of alleged fraud schemes involving various treatments and services that were not medically necessary -- and, oftentimes, were never even provided."

The crackdown netted 11 doctors, three nurses and 10 licensed health professionals.  The charges were filed in Baton Rouge, Louisiana; Brooklyn, New York; Chicago; Dallas; Detroit; Houston; Los Angeles and Miami.

Half of the defendants came from South Florida, the reputed national leader in Medicare fraud.

Copyright 2011 ABC News Radio

Friday
Aug262011

$15 Million Medicare Fraud Owner Sentenced to Prison 

Stockbyte/Thinkstock(DEARBORN, Mich.) -- The operator of a phony health center who scammed the government out of $15 million will spend 48 months in jail.

Court documents show the Sacred Hope Medical Center and Dearborn Medical Rehab Center collected millions from medicare for phony treatments, over several years, and paid kickbacks to phony patients, who claimed they were getting health care.

The owner of the bogus centers, Jose Rosario, has now been sentenced by a federal judge in Michigan to 48 months in prison and ordered to pay more than $10 million in restitution after the justice department's medicare fraud strike force and the FBI shut down the operation.

Copyright 2011 ABC News Radio

Sunday
Feb062011

Government Releases Health Care Fraudsters Most Wanted List

Image Courtesy - Getty Images(WASHINGTON) -- Health care fraud has cost American taxpayers millions of dollars in recent years, and now the Office of the Inspector General has announced a top-ten list of people most wanted for exploiting the system for their personal gain.

While the OIG says health care fraudsters have cost taxpayers $124 million in total, there are a few notable fugitives who account for a large part of the missing money.

Three brothers working out of Miami allegedly ripped off Medicare for $110 million. One woman took Medi-Cal, the Medicaid program in the state of California, for $17.1 million, authorities say. The OIG says another man billed Medicare for $1.1 million.

Overall OIG says it is tracking about 170 fugitives, but that two of the top ten most wanted have been taken into custody. The organization stressed that it needs all the help it can get from the public, and offers both a phone number and online form to report a fugitive.

The most wanted list is available online at http://www.oig.hhs.gov/fugitives.

Copyright 2011 ABC News Radio

Monday
Jan242011

Feds Recovered $4 Billion in Gov't Medical Fraud in 2010 

Photo Courtesy - Getty Images(WASHINGTON) -- Last year was the biggest ever for shutting down efforts to scam federal health care programs. Prosecutors recovered a record-setting $4 billion from hundreds of crooks, big and small.

“The subjects of our investigations include traditional fraudsters, health care providers, corporate executives, hospital systems and administrators and members of organized crime,” said FBI Assistant Director Kevin Perkins at a news conference in Washington Monday.

Federal officials also announced new rules to make it harder for would-be criminals to defraud the government in the future.

“The days when you could just hang out a shingle and start billing the government are over,” said HHS Secretary Kathleen Sebelius.

Among the new rules, which are part of the health care law the House voted last week to repeal, is one that allows Medicare to stop all payments to a provider the moment a credible complaint about fraud has been received. This may terrify executives at some big corporations that sell billions of dollars' worth of drugs, devices and services to the federal government. Major companies like Novartis, AstraZeneca and Allergan, for example, were the subjects of successful fraud investigations last year.

Copyright 2011 ABC News Radio

Wednesday
Jan052011

BMJ Declares MMR Study 'Elaborate Fraud'

Photo Courtesy -- ABC News(LONDON) – An article in the British Medical Journal has declared that a study that linked the MMR vaccine to autism was “an elaborate fraud” that may have led to the preventable disease and death of children.

In an editorial, the BMJ has charged that a 1998 study in Lancet by Andrew Wakefield was not just bad science, but rather a deliberate falsification of data. The journal’s editor-in-chief, Fiona Godlee, has called for an investigation into Wakefield’s other studies to determine if they too should be retracted. Lancet itself retracted the article a year ago, saying it contained elements that were “incorrect.”

Godlee has likened the scare caused by the article to the Piltdown man, the paleontological hoax that convinced people for 40 years that the missing link between man and ape had been found.

In a series of three articles, Godlee, along with deputy BMJ editor Jane Smith and leading pediatrician and associate BMJ editor Harvey Marcovitch, conclude that there is “no doubt” that it was Wakefield who perpetrated the fraud. Meanwhile, they say he has denied any wrongdoing.

“Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. Meanwhile the damage to public health continues,” they said.

Medical experts have declared outrage over the article, questioning how many parents may have kept their children from vaccines based on Wakefield’s study.

 “We can only wonder how many children may have died or suffered debilitating illnesses because of this slander against a powerful medical tool that could have saved them, and how many still will before the autism scare is finally put to rest,” said Robert Field, professor of Law at Drexel University.

Some also question the study’s effect on the public’s trust in science.

“Andrew Wakefield has done inestimable damage to the public health both in the U.S. and Europe,” said Bill Schaffner, chairman of Preventive Medicine at Vanderbilt. “Bad enough when his work was thought to be a combination of inept science and misguided hucksterism – now there are allegations of premeditated fraud!”

And if those allegations are correct, could Wakefield be charged criminally or civilly in England or the U.S.? According to British and American legal experts, prosecutors would have to prove that Wakefield deliberately and knowingly published false information for personal gain. Furthermore, they would have to prove the study was a "substantial factor" in parents' decision to forego vaccination and that Wakefield could have "reasonably foreseen" kids getting sick because of his fraudulent study.

Copyright 2011 ABC News Radio







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