We get a chill up our spine when people say Medicare fraud is a victimless crime. It’s not just taxpayers that get ripped off. Very often patients are harmed by the very doctors they trust with their care. In this post we examine a 70 year old obstetrician-gynecologist now facing 465 years in prison after performing dozens of medically unnecessary surgeries… surgeries that are also irreversible.
Dr. Javaid Perwaiz is a long time physician in the Hampton Roads area of Virginia. Countless babies have been delivered by him but he also endangered and ruined the lives of many women.
On November 9th, a federal jury convicted Perwaiz of 52 counts of fraud. He faces 465 years in prison when sentenced next year. No matter what his sentence, he will likely die in prison.
According to court records and evidence presented at trial, Dr. Perwaiz scheme began in 2010 and continued until his arrest last year. During that period, he billed both private insurance companies and Medicaid millions of dollars for irreversible hysterectomies and other surgeries and procedures that were not medically necessary for his patients.
Often Pervaiz told his patients they needed surgery to avoid cancer. He was lying. His interests were not the medical wellbeing of his clients, instead he was focused on the insurance money.
Sadly, several of his former patients testified they suffer pain or other complications because of the unneeded surgeries. The hysterectomies they received can’t be reversed they can never have children.
To keep his staff from speaking out, he reportedly provided them lavish gifts. One nurse testified the value of the gifts she received was several hundred thousand dollars.
Although over 50 witnesses testified for the prosecution, Perwaiz only had one witness for his defense. He also took the stand.
Perwaiz’ lawyers argued that he was hard-working, dedicated, and highly skilled doctor who only acted in the best interest of his patients. The jury wasn’t convinced.
The district’s top federal prosecutor says, “Dr. Perwaiz preyed upon his trusting patients and committed horrible crimes to feed his greed. Dr. Perwaiz has a history of fraud including having his medical license and hospital privileges revoked. Nothing was going to stop him but the brave victims who testified against him and law enforcement. My thanks to the trial team for their outstanding work in what was a very complex case, and to our investigative partners for their efforts…”
The number of agencies and the number of press releases show an alphabet soup of state and federal agencies were involved in the investigation. This speaks volumes about how concerned authorities were once the investigation began. Doctors take an oath to do no harm. A 12 person jury found that Perwaiz had instead put patients before profits.
Whistleblower Rewards and Healthcare Fraud
What isn’t in the media is how Perwaiz was caught. Although some of his patients may have had a suspicion, most believed him as he was their trusted OB-GYN. A hospital worker where Perwaiz performed the surgeries blew the whistle. And that brave action probably saved many other women from a similar fate.
Under the federal False Claims Act, whistleblowers with inside information about fraud involving government healthcare programs can receive a reward for reporting healthcare fraud. The rewards range between 15% and 30% of whatever the government collects from the wrongdoer.
In this case absent a “Hail Mary”, Dr. Javaid Perwaiz is headed to prison when sentenced in March. The government can still forfeit any assets that are the result of the millions of dollars he received in overpayments.
To learn more about how you can obtain a cash whistleblower reward, visit our healthcare fraud whistleblower page. 29 states also have rewards for state funded Medicaid fraud information. (Two states, California and Illinois have reward programs for fraud involving private health insurance.)
Whistleblowers are the new American heroes. Our mission is to help brave healthcare workers stamp out fraud and collect the maximum rewards possible.
Medical Necessity and Accepted Standard of Medical Practice
Of all the types of healthcare fraud, medical necessity is one of the most difficult to prove.
Let’s take a doctor who bills for a one hour office visit but only spends 5 minutes with the patient. That same doctor then bills for 37 one hour visits during a 24 hour period. That is an easy fraud to prove.
But medical necessity requires a more subjective determination. Two doctors can legitimately disagree on whether a procedure is necessary or not. Afterall, that is why so many patients get second opinions. Simply because one doctor disagrees doesn’t mean the other is committing fraud.
Medicare, Medicaid and most private health insurance plans will only pay for services that are medically necessary. Specifically, for government funded programs, the services must be “reasonable and medically necessary.”
Looking to the Centers for Medicare and Medicaid Services, (CMS) they define the term “medically necessary” as follows:
“Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.”
So, what does the phrase “accepted standard of medical practice” mean? CMS also defines that. The definitions, however, are not black and white.
Courts have been struggling with medical necessity cases for years. The accepted standard can’t be completely subjective. Instead courts look for help from experts and the current generally accepted standards of medical practice in a particular specialty.
As this case show, ultimately a jury may have to decide if a doctor went too far.
To learn more or to see if you are eligible for a reward, contact us online, by email firstname.lastname@example.org or by phone 202-800-9791. All inquiries are protected by the attorney client privilege and kept strictly confidential. We accept cases nationwide.
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