A New York physician who worked for years as an orthopedic surgeon was found to be fraudulently inflating charges and billing for surgeries that he did not perform – billing for 20 surgeries in a day or recording that he was seeing 60 to 90 patients a day. While he was waiting to be sentenced for that crime, prosecutors now say he was committing another crime posing as another doctor and reviewing medical records in coverage disputes, potentially impacting thousands of patients and their cases.

Spyros Panos pled guilty in 2013 to his initial fraud and gave up his license to practice. Now he is charged with wire fraud, health-care fraud and aggravated identify theft while working on medical and workers’ compensation claims though he has pled not guilty. He collected $870,000 since 2013 using a shell company and another physician’s credentials.

Insurers are now facing issues with privacy and the reliability of past patient reviews. Marc Rodwin, professor at Suffolk University Law School in Boston said that a review conducted by someone pretending to be someone else “is unreliable and it should be thrown out” but also states that in this situation it’s a little more difficult to know what to do. A patient who had a review a few years ago may have since moved on. This is also a security and privacy issue, and health plans and providers are obligated to report breaches of personal health information to their patients and authorities.

At least 2,500 people have been affected according to data compiled by Bloomberg, but the full scope of the investigation is not yet public. Whether or not his reviews resulted in workers’ comp claims or treatments being denied is not yet fully known. He reviewed more than 200 claims in Connecticut alone, and according to state officials he recommended denying most of them. Stephen Morelli, chairman of the Connecticut Workers’ Compensation Commission said that even though he recommended denying them, many of the claims were still paid and none of the decisions are currently under dispute. The Hartford, who contacted the group when they discovered the fraud, is offering a fresh independent review to patients whose claims may have been impacted by Panos.

Insurance companies who may have indirectly used his services include Anthem Inc., Health Care Service Corp, and The Hartford. They have contacted patients and are evaluating the cases he may have been involved in. Other insurers have notified patients that their privacy was violated but have not yet told consumers if claims he worked on will be examined.

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