Aug 132018
 

In June, I posted an item about how BCBS of Illinois was notifying people after a vendor informed them that law enforcement had alerted them that a vendor’s employee was not a licensed physician but an identity thief.

That story did not seem to get a lot of press attention, but subsequent revelations named the physician in question as Spyros Panos of New York, a physician who had surrendered his license in 2013 after pleading guilty to healthcare fraud.

While Panos’s deception impacted less than 100 Iowa residents, and there is no indication that he misused those patients’ information, a recent report by Gallagher Bassett to the California Attorney General’s Office indicated that 1,294 workers compensation claimants in the state were affected. Their report also suggested that there were a number of entities involved in the chain. Gallagher Bassett, the third party administrator, wrote that to assist clients in providing compensation claims services,

Gallagher Bassett engages third parties who specialize in peer reviews, including Dane Street LLC and Coventry Health Care Workers Compensation, Inc. (“Coventry”).

Dane Street was the vendor involved in the BCBS of Illinois notification. A footnote to Gallagher and Bassett’s notification added:

In this matter, Coventry engaged Advanced Medical Reviews (“AMR”).

Panos worked for a number of these specialist physician review vendors, and any company he worked for would have been notifying clients of the problem.

The referenced federal case is U.S.A. v. Panos, No. 7:18-mj- 02963-UA-1 (S.D.N.Y. 2018) (Doc. 2). Looking at the complaint, it appears that Panos allegedly started this scheme early (2013) and with the possible assistance of family members.

So given that Panos appears to have been doing this for years, how many patients had their protected health information disclosed to this alleged identity thief? Should we be seeing this on HHS’s public breach tool, because I haven’t seen it — at least not from Dane Street or Coventry or Advanced Medical Reviews.

DataBreaches.net sent Dane an inquiry asking whether this was reported by them, by their clients, or by neither to HHS. This post will be updated as more information becomes available.

And while I have your attention:  this incident does not have the makings of a mega-breach in terms of numbers. But what about the cost to businesses who hired him or relied upon him?  And what about the people whose cases he reviewed? Would someone who was so unethical as to engage in healthcare fraud hesitate to find a claimant ineligible for compensation if such a recommendation might make companies more likely to refer cases to him, knowing that companies do not want to be giving away a lot of money on claims?  Should all those whose cases were reviewed by him be seeking to appeal and a re-opening of their claims if he recommended denial of claims? What costs will attach to THAT?

 

 

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