Issue link: https://beckershealthcare.uberflip.com/i/583494
30 Coding, Billing & Collections Orthopedic Surgeon Faces Conspiracy, $150M Fraud & Aggravated Mayhem Charges: 6 Key Notes By Laura Dyrda M unir Uwaydah, MD, a California orthopedic surgeon, was ar- rested in Germany after being charged in a huge health fraud scheme including unnecessary surgery, according to an ABC News report. Dr. Uwaydah is accused of allowing his physician's assistant to perform sur- gery without supervision on his patients. The patients sustained injuries and psychological trauma after these procedures. Here are five key notes on the case: 1. Dr. Uwaydah and 14 associates are charged with a single conspiracy count, 32 counts of insurance fraud, three counts of illegal client referrals and 18 counts of aggravated mayhem. e associates include another physician and a lawyer. info@physiciancontrol.com or call 404.920.4950 www.physiciancontrol.com At IMS affiliated ASCs, physician owners are involved with decision making for the organization, a rare concept in today's ASC environment. IMS specializes in development and management solutions for all types of ASCs. Our emphasis on physician control and our no-nonsense ap approach set us apart from traditional ASC management companies. Our experience allows us to finalize transactions quickly, so you can focus on what matters: your patients. Let us show you how partnering with IMS can enhance your center's success through physician control. Interventional Management Services Less Red Tape. More Time For What Matters. California ASCs to Settle Out-of- Network Class Action With United Health: 5 Key Notes By Laura Dyrda H ooper, Lundy and Bookman filed a motion for prelimi- nary approval to settle a class action complaint filed more than six years ago on behalf of out-of-network California ambulatory surgery centers against United Healthcare Services and OptumInsight. Here are five things to know: 1. e complaint alleges United and OptumInsight improperly calculated the reasonable and customary amounts for out-of- network ASCs, leading to millions of dollars in underpayments. 2. United agreed to a $9.5 million settlement fund. 3. ere are an estimated 250 ASCs that could qualify to par- ticipate in the settlement, if the court preliminarily approves the settlement. Steps to participate in the settlement will be sent to all potential class members. 4. e class representatives came from Downey Surgical Clinic and Tarzana Surgery Center. 5. e case challenged payment calculations of reasonable and customary amounts under employer-provided healthcare benefit plans and health insurance policies governed by the Employee Retirement Income Security Act. "Aer a long battle, we believe that we have reached a fair settle- ment that will adequately compensate the class of surgery centers whose claims were underpaid," said HLB Attorney Daron Tooch, a lead attorney representing the ASCs. n 2. e group is accused in the $150 million insurance scheme. Eleven of the co-defendants are held with bail as high as $21.5 million and Dr. Uwaydah is awaiting extradition from Germany. 3. e case includes Dr. Uwaydah's office assistant who was acquit- ted of murdering his ex-girlfriend two years ago. Dr. Uwaydah and his ex-girlfriend's father were involved in a failed business deal; Dr. Uwaydah was never charged in the case. 4. e case also includes a "conspiracy to pay attorneys and mar- keters up to $10,000 a month to illegally refer patients." Workers' compensation patients were among those illegally referred to Dr. Uwaydah and his related businesses. 5. In addition to the initial counts, Dr. Uwaydah and his physician's assistant were charged with three more counts of aggravated may- hem. Dr. Uwaydah's lawyer is also charged with conspiracy to com- mit insurance fraud, money laundering, illegal patient referrals and filing tax returns in a related 75-count indictment. 6. Dr. Uwaydah faces life in prison if convicted. n