Straight Out of a Horror Story: Insurance Fraud Scam Includes Unlicensed Worker Performing Surgeries Under the Watch of Crooked Orthopedic Surgeon
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:
- 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.
- 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.
- 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.
- 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.”
- 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.”
The staff at ICU Investigations has recently implemented the utilization of mobile voice technology in an effort to optimize efficiency and enhance the integrity of surveillance investigative reports, especially for insurance fraud investigations. Whether the claims are in auto, property, health or workers’ compensation, investigators need the ability to document their observations at a moment’s notice with increased flexibility.
As we all know, surveillance efforts must be carefully recorded, in conjunction with the investigator’s comprehensive logs and notes. However, in instances of mobile surveillance or covert operations, capturing video is not always possible. Professional dictation recorder applications allow investigators to quickly and efficiently document their observations (much, MUCH faster and easier than writing notes) and most importantly, specific details can be dictated as they are happening, so nothing is lost, tainted or distorted by memory. Everything they see, you are aware of, even when video evidence can not be obtained.
Furthermore, the investigators are then able to take all of their dictated information on their smartphone or tablet and immediately send it to our internal staff for review!
The ICU staff is always looking for ways to add value and integrity to our work in an effort to meet and ultimately exceed YOUR expectations. Mobile voice technology is just one piece of the puzzle we have implemented as part of a grand scheme for our technological future. Suspicious? GET ANSWERS TODAY!
According to Yahoo News and the Associated Press, 60-year-old James Douris of Upper Makefield, PA has been charged with perjury following a court proceeding from 2014 and entered a guilty plea late last month. Douris has filed over 30 lawsuits claiming severe disabilities that restrict him from walking, holding a glass of water, or doing anything else for that matter.
Thanks to investigators, the perjury charge came to light after Douris was documented pushing around a wheelbarrow, standing on a ladder, and utilizing a power saw, all after he claimed he couldn’t even pick up court papers that were served at the foot of his front door.
According to Yahoo News, “Douris, an unemployed veteran, has sued municipalities, officials and businesses claiming his various physical disabilities haven’t been accommodated over the past few decades. Nearly all have been thrown out of court.”
But we want to know, how can anyone take you seriously with over 30 lawsuits under your belt, including one loss in 2010 in which Douris considered his dog a dependent and therefore should be eligible for food stamps because his dog ate the same food as he did?
This isn’t Douris’ first rodeo with perjury, either. He was convicted of perjury not long before last month’s plea for creating a fictitious invoice for the cost of repairs to his yard while suing a tree company for damage. The invoice for repairs was from a non-existent company.
Douris left the courtroom in a wheelchair after entering his guilty plea and is set to receive a psychological evaluation before ultimately facing sentencing within the next 2 months.
You are most likely already aware that more courts are deeming social media evidence admissible in court, and we now have more proof of that thanks to a recent Florida case featuring a plaintiff involved in a slip and fall at a Target store.
In an article by Tom Paradise, Esq. and Nicolette John, Esq. of PropertyCasualty360.com, they tell us that the attorneys for Target requested that the plaintiff, Maria F. Leon Nucci, produce “private” photographs that she had posted on her Facebook account. These photographs, in conjunction with surveillance evidence, were contrary to the plaintiff’s claim for personal injuries, mental anguish, and pain and suffering.
Of course, the plaintiff objected. But the court ordered the plaintiff to provide the photographs on her cell phone, as well as photographs she had posted on her social media accounts.
The plaintiff appealed the social media postings only, claiming that her Facebook is set to “Private” and that this motion would be invading her privacy according to the Federal Stored Communications Act.
According to Paradise and John, the appellate court replied with:
- “The photographs being sought were reasonably calculated to lead to the discovery of admissible evidence as they are ‘powerfully relevant to the damage issues in the lawsuit’ and further stated that ‘there is no better portrayal of what an individual’s life was like than those photographs the individual has chosen to share through social media.’”
- “The plaintiff’s privacy interest in such posted photographs was minimal, if any. The court stated that ‘before the right to privacy attaches, there must exist a legitimate expectation of privacy’ and that they ‘agree with those cases concluding that, generally, the photographs posted on a social networking site are neither privileged nor protected by any right of privacy, regardless of any privacy settings that the user may have established.’”
- “The court held that the expectation that such information shared through social networking websites is private is not a reasonable one. As the Court aptly stated, ‘Facebook itself does not guarantee privacy. By creating a Facebook account, a user acknowledges that her personal information would be shared with others. Indeed, that is the very nature and purpose of these social networking sites else they would cease to exist.’”
Also note that the plaintiff’s appeal regarding the invasion of privacy according to the Stored Communications Act does not come into play for this case, as the act stops the provider, such as Facebook, Twitter, etc., from exposing the information. The photographs were requested from the plaintiff who was in complete control of her electronically stored communications.
WIN, WIN, WIN!
Criminal record checks are crucial to the insurance and law industries for many reasons. Someone with a rap sheet longer than the Declaration of Independence, including insurance fraud charges, can easily be discredited in terms of their claim after acquiring the record from the state using a simple request. Some states utilize quick and easy online systems, while others require requests to be sent in via mail, but unfortunately, many states do not release criminal records at all or without fingerprints and/or a signed authorization from the subject.
Here is a detailed, alphabetical list of our processes for conducting criminal checks in all 50 states (and Washington D.C.):
Please note, when a state’s process says, “No statewide criminal check available,” we mean that there is no public criminal record access. Some of these states are closed-record states or require approved vendors, and some states we have yet to receive requests for, as we always research methods to obtain the records.
Alabama: No statewide criminal check available.
Alaska: No statewide criminal check available.
Arizona: No statewide criminal check available.
Arkansas: A signed authorization from the subject is needed.
California: A signed authorization from the subject is needed. You also need to be an approved vendor by the state of California; they will not allow third-party requests.
Colorado: Available online.
Connecticut: Available by mail.
Delaware: No statewide criminal check available.
Florida: Available online.
Georgia: Available online.
Hawaii: Available online.
Idaho: Available by mail.
Illinois: Available by mail.
Indiana: Available online.
Iowa: Available online, but only released arrest information within the last 18 months. A signed authorization from the subject is needed for a complete criminal record.
Kansas: Available online.
Kentucky: Available by mail.
Louisiana: No statewide criminal check available.
Maine: Available online.
Maryland: Available online.
Massachusetts: Available by mail.
Michigan: Available online.
Minnesota: No statewide criminal check available.
Mississippi: No statewide criminal check available.
Missouri: Available by mail.
Montana: Available online.
Nebraska: Available online.
Nevada: A signed authorization and fingerprints from the subject are needed.
New Hampshire: No statewide criminal check available.
New Jersey: Available by mail.
New Mexico: A signed authorization from the subject is needed.
New York: Available by mail.
North Carolina: Available via third-party.
North Dakota: No statewide criminal check available.
Ohio: Fingerprints from the subject are needed.
Oklahoma: Available by mail.
Oregon: Available online.
Pennsylvania: Available online.
Rhode Island: No statewide criminal check available.
South Carolina: Available online.
South Dakota: No statewide criminal check available.
Tennessee: Available online.
Texas: Available online.
Utah: No statewide criminal check available.
Vermont: Available online.
Virginia: A signed authorization from the subject is needed.
Washington: Available by mail.
Washington D.C.: A signed authorization from the subject is needed.
West Virginia: A signed authorization and fingerprints from the subject are needed.
Wisconsin: Available online.
Wyoming: No statewide criminal check available.
It must also be noted that each state has different policies, different time frames of recorded records, and pricing. And finally, each state will only have criminal records for crimes committed in said state. For example, if the subject lives in New Jersey but committed a crime in Pennsylvania, searching New Jersey’s criminal records will not give you any crimes committed out of state.
When in doubt, please do not hesitate to give us a call and discuss each state’s policies and requirements!
Anything and everything that could possibly get in the way of surveillance efforts can and will most likely happen. Luckily, investigators at ICU spend ample time profiling the subject, neighborhood and surrounding areas, as well as preparing and planning to adapt when the occasion arises.
With claimants more aware of the consequences and detriment surveillance can have on their cases, we know it’s best not to jump in, guns blazing (not literally). The best approach is to ease slowly into the case and allow sufficient time to get accustomed to the claimant’s habits and daily activities. Once comfortable and aware of our surroundings, we can get increasingly aggressive in our efforts.
In some cases, it is better to rotate the vehicle used during surveillance by either switching cars or utilizing multiple investigators in the event that one is discovered.
If we’ve learned anything about people during surveillance, it’s that they’re extremely nosy and they think everything is about them. Neighbors and other forces get in the way quite often, whether by taking matters into their own hands and knocking on our car windows or even by calling the police (which then infinitely draws more attention and compromises the surveillance vehicle). Sometimes, no matter the techniques we’ve learned over the years, something (or most likely, someone) will get in the way. However, our seasoned investigators learn to adapt to their surroundings. We anticipate these things happening, and this is why we have a proven success rate for over 18 years throughout the Tri-State area.
But the best way we can describe adapting to these counter-surveillance forces is quoted in an article by Steve Koenig of Pursuit Magazine. Koenig says, “Visualize how you might look from the other side looking out on your surveillance vehicle. Successful surveillance operatives have vehicles, clothing and skills that allow them to blend into their surroundings. The trick is NOT to be tricky. The trick is NOT to be invisible. The trick is to be unremarkable.”