• Dean Smith

Straight Out of a Horror Story: Insurance Fraud Scam Includes Unlicensed Worker Performing Surgeries

With Halloween’s recent pass, we felt it was only right to include this article, straight out of a horror story. This is what nightmares are made of.According to Claims Journal, 49-year-old Dr. Munir Uwaydah, an orthopedic surgeon in Los Angeles, in conjunction with his colleagues, orchestrated a massive $150 million insurance fraud scam. As if the insurance fraud scam wasn’t enough, Uwaydah employed an unlicensed and untrained physician assistant to perform surgeries on countless patients, leaving them scarred for life and in need of multiple corrective surgeries.As part of the insurance fraud scheme, Uwaydah and co-conspirators prescribed patients medication that was overly expensive and completely unnecessary, saw patients for a total of two minutes and then billed the appointments as if they were an hour long, and also manipulated medical records and MRI results in order to get approval for pointless operations.Claims Journal notes that “Fifteen people have been indicted in the scheme that paid marketers and workers’ compensation lawyers up to $10,000 a month in kickbacks to funnel patients to Uwaydah’s clinic. They got bonuses if the patients were candidates for surgery and additional cash if they received operations, the indictment said.” Furthermore, if patients were hesitant to go through with the surgeries recommended, Uwaydah offered them compensation as well.The complexity of the scheme and crimes get even worse. Refer to the prosecutor notes below:

  1. Prosecutors said Uwaydah escaped to Lebanon, his home country, in 2010 after an investigation identified fraud as a possible motive in the 2008 strangling death of Juliana Redding, an aspiring model he once dated.

  2. Uwaydah denied any involvement in Redding’s death. He was never charged. However, Uwaydah’s former personal assistant/office manager was charged with murder, but she was acquitted.

  3. The office manager, 49-year-old Kelly Soo Park, is now being held on $18.5 million bail in the fraud case, but her lawyer doubts that prosecutors can prove her involvement.

  4. However, “Deputy District Attorney Catherine Chon said that Park placed her name on shell companies and bank accounts for Uwaydah and attended weekly meetings where the doctor and others discussed ways to hide his assets from insurers, creditors and law enforcement.”

  5. These meetings featured discussions about a state medical board case against Uwaydah. The case alleged that Uwaydah allowed physician assistant Peter Nelson to perform surgeries at an Orange County Hospital in 2005.

44-year-old Peter Nelson is the unlicensed and untrained physical assistant noted above. The Physicians Assistant Board has cited Nelson twice, with his most recent indiscretion described as a patient complaining about him failing to provide anesthesia while removing 2 feet of surgical gauze left for a month in an incision from shoulder surgery (that he initially performed), according to public records. Uwaydah was sued for malpractice in this case for leaving the gauze in the incision, which then became painfully infected and was not subsiding after antibiotics. The gauze was found a month after the surgery by an x-ray.Uwaydah and Nelson have both been charged with 21 counts (each for a different patient) of aggravated mayhem as well as dozens of insurance fraud charges, but prosecutors believe that this is only a fraction of their victims. Nine other defendants are charged with mayhem and insurance fraud charges as well.Uwaydah was arrested in Germany on September 9th, 2015 and is currently awaiting extradition.Deputy District Attorney Catherine Chon notes that the indictments “paint a clear picture of a sophisticated and savvy group of criminal conspirators who placed profits above the health and welfare of the thousands of patients they purported to treat. The callous disregard and extreme indifference that was shown to unsuspecting victims is reflected in the overt acts alleged.”Source

#fraud #insurance #scam #surgeries

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