50-year-old Spyros Panos, an ex-orthopedic surgeon, saw dozens of patients a day at his suburban medical group in New York. Over the years, he was billing for surgeries never performed and inflating charges. After being caught, his first criminal scheme shutdown, only to be followed by another: medical insurance fraud. 

During this new stage of fraud, Panos posed as another doctor. With his new identity, he reviewed thousands of patient medical records, affecting over 2,500 individuals nationwide. According to state officials, he denied almost 200 medical and workers’ compensation claims. Some of the allegations and charges against him include:

  • Wire fraud
  • Identify theft
  • Medical malpractice
  • Falsifying medical records

After a decade-long of criminal activity, Panos earned over $7.5 million. Court records indicate that he performed up to 20 surgeries daily, and saw anywhere from 60 to 90 patients a day in his office.

Analyzing industry vulnerabilities

The length of Panos’s criminal history raises questions about security and accuracy in the medical review industry. Some companies told authorities that they are working on preventing posers from infiltrating the system. However, the industry has yet to present any preventative measures. Anthem Inc, Health Care Service Corp. and The Hartford were just a few insurance companies using Panos’s fraudulent services.

The medical review industry started in the 1990s, during a time insurance companies were often unethically denying claims. The six independent review companies Panos worked for are still under wrap. The claims he denied in Connecticut are currently under new reviews.