Disgraced formerorthopedist Spyros Panos is facing new federal charges, accused of committing health care fraud whileservinga prison sentence for another multi-million dollar health care fraud.
TheHopewell Junction man was charged with health care fraud, wire fraud andaggravated identity theft, according tothe New York State Inspector General's Office and the U.S.Attorney for the Southern District of New York.
The 49-year-old Panosis accused of stealing another physician’s identity to bill more than $860,000 for Workers’ Compensation case reviews that he was not licensed to perform—after his previous arrest and while serving a federal prison sentence for another health care fraud.
SETTLEMENT:Panos cases end, settlement for 256 malpractice lawsuits
LAWSUITS: Panos out of prison, faces medical malpractice suits
He was arrested at his Hopewell home on Tuesday morning andcharged later that day in White Plains federal district court beforeU.S. Magistrate Judge Paul Davison.
It's unclear who is Panos' attorney of record.
“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," Inspector General Catherine Leahy Scott said in a statement. "The alleged actions behind these new charges demonstrate his apparent lack of remorse and a clear disdain for making an honest living."
Leahy Scott said she will continue working with federal and state law enforcement agencies to "help ensure the integrity of the Workers’ Compensation system while pursuing practitioners hoping to build their own wealth without regard to the law or fair play.”
From September 2013 through last October — both before and after Panos was released from federal prison after serving time for an unrelated health care fraud — he allegedly devised a scheme to defraud a health care benefit program, getting companies topay him more than $860,000 in fees for conducting peer reviews of patient files in connection with workers' compensation claims.
Panos assumedthe identity of a licensed physician, falsely represented himself to be that physician, reviewed files, and submitted reports to the peer review companies from a computer in Hopewell Junction, according to a complaint filed inWhite Plainsfederal court.
The investigation was conducted by Inspector General Leahy Scott, the U.S. Office of Health and Human Services, Office of the Inspector General, the U.S. Postal Inspection Service and the office of the U.S. Attorney for the Southern District of New York.
The alleged scheme
A licensed, independent doctor can perform peer reviews in connection with medical treatment relating to workers' compensation claims, when a treating physician requests a variance (variation) in treatment, according to the complaint. That doctor analyzesthe patient's file, but does not examine the patient, and writes a report opining whether the variance is appropriate.
Companies supply doctors to conduct such peer reviews. Prior to being assigned to conduct the reviews, a doctor must establish proper credentials.
According to authorities and the complaint filed in federal court:
In 2013, a month before Panos pleaded guilty to one count of felony health care fraud, an email address was created in the name of the physician whose identity Panos is accused of stealing.Many emails sent and received using that email account allegedly originated from a computer at Panos’ Dutchess County home.
AroundDecember 2013— a month after Panos pleaded guilty— a company called Excel O was formed by a relative of Panos, who is not a licensed physician. The company’s address corresponded to a Brooklyn building owned by another relative.
Using the identity and credentials of another physician, Panos allegedly billed six companies more than $860,000 for peer reviews of Workers’ Compensation medical examination reports.The six companies sent checks for payment of services to that company were deposited into Excel O LLC’s Dutchess County bank account.
Some of the fraudulent exams were allegedly conducted after Panos pleaded guilty and surrendered his medical license, but before beginning his federal prison sentence for the previous health care frauds began.
Panos was sentenced to 4½ years in federal prison (which he started serving in April 2014)followed by two years of supervised release, and ordered to pay millions in restitution and to the government.
In late 2016, he was released to a halfway house, then to home confinement in Hopewell Junction. During the home confinement,Panos again started using another physician’s credentials and billing for the examination reviews, authorities said.
Medical malpractice
Panos was facing hundreds of civil medical malpractice lawsuits.A settlement agreement reached in February could mean up to $40 million for the 256 plaintiffs suing Panos.
Attorney Christopher Meagher of theMeagher & Meagher law firm, who represented more than two dozen civil plaintiffs, said at the time that "maximum payout for all claimants, combined,might approach" $40 million.
"However, it is also possible it will come in considerably less because of the legal insurance coverage issues," Meagher said then.
Panos—who has been accused ofbotching surgeries, doing unnecessary surgeries on healthy patients and more — will not admit to medical wrongdoing as part of the settlement.
Nina Schutzman: nschutzman@poughkeepsiejournal.com, 845-451-4518, Twitter: @pojonschutzman
