Do you want your gynecologist to give you a facelift?
If you're not paying attention, that just may be what happens.
Plastic surgeons, generally, are not subject to the same strict laws that most doctors must follow. They can operate in their offices, and no one usually comes around to follow up and check on cleanliness, staff competency or other criteria which most patients assume is being managed by some regulatory agency.
Thousands of individuals-- many recent immigrants and unfamiliar with the country's health care system -- volunteer to undergo medical examinations and procedures. Traveling to surgery centers like Southern California and New York State, they receive free, or reduced, surgery. Others get cash.
The victims, some who traveled from as far as Tennessee, were the unwitting key to a popular scam.
Federal, state and insurance company inspectors have untangled what is being described as one of the "most outrageous" cases of physicians mismanaging the confidence placed in them. The sort of fraud -- which lives in a web of surgeons, plastic surgery center owners and victim recruiters, known as "cappers," is difficult to find and stop. A recent California case is just the start.
California Dreamin'
In the summer of 2015, federal and state prosecutors charged several plastic surgery center owners with fraud. Now, Blue Cross and Blue Shield groups are following their lead and filing suit.
In the view of investigators, it isn't just the physicians pulling a scam. There are many people who are engaged in doing the wrong thing. No one has a reason to become a whistle blower.
The attempt to recognize plastic surgery centers involved in fraudulent billing had its genesis in a regular conference of health insurers in January 2003, in Tampa, Florida. The officials convene three times a year to connect notes and look at unusual activity. The 2003 session was unusual because insurer after insurer had seen the same thing: victims were traveling hundreds and thousands of miles to experience routine plastic surgery procedures.
At most major insurers, advanced software examines claims for strange patterns. When a suspicious pattern is identified, inspectors step in. No one is quite certain why the early movement was concentrated in Southern California, but various individuals in the probe said one motive may have been that California, like other states, has a "quick pay" law which mandates that insurers handle applications in as little as 30 days. Plastic surgery centers could secure payment before adjusters were able to completely analyze a claim's validity.
While it is hard to understand what occurs inside the clinics, some previous victims have talked. Julio Hernandez and his spouse, Sandra, of Phoenix, is one couple who have spoken out.
When Mr. Hernandez, employed by a garbage disposal company, found that he and his wife could make a few hundred dollars and get a free medical checkup, they thought they had found a good deal. All that was required was to visit the Unity plastic surgery center in Anaheim, California and they would receive $400 -- or more -- for each procedure.
"I could get the money I needed," said Ms. Hernandez, who brings home $7 an hour as a textile worker. She traveled to the center in Anaheim in the summer of 2012. They recognized that something was amiss when they got checks from insurers for tens of thousands of dollars. An attorney for the center phoned to insist the money be returned and frightened them with a civil prosecution and jail time.
Health care fraud is constantly morphing, says Bruce Chambers, director of Cigna's special investigations unit.
"What they were doing was cosmetic surgery, and they were billing it to insurers as other medical procedures," said Chambers. "The patients would go in for a tummy tuck and would get a bill for hernia surgery."
A group of women from Texas has filed a civil lawsuit against the center where they underwent plastic surgery. The ladies took a couple of smart steps when they realized they had been part of a scam: They retained an attorney and deposited the money received from insurers into a court account.
The women are not alone in suing the clinic. In a lawsuit last year, Aetna accused the center of performing unneeded procedures. Aetna's suit contends that the center is "in whole or in part, a sham entity established to bill for services rendered by Unity.
The criminal cases in Southern California have helped reduce the number of fraudulent claims there, bu like whack-a-mole, fraudsters keeping popping up elsewhere.
New York's Dangerous Cosmetic Surgery
One tangle in the spaghetti bowl of tangled New York laws allows any doctor to provide cosmetic services -- there doesn't even need to be an anesthesiologist or nurse in the room.
A few women who wanted to get firmer and increase the curves went to Dr. Ayman Shahine to get some fat sucked out and shifted around and bigger boobs.
What they hadn't counted on - and here's where a little Google-time can help - was Shahine not being a plastic surgeon. Shahine is a gynecologist and has been named in numerous lawsuits.
Carolyn Robinson was one lady who was sold on Shahine when she learned the names of stars on which the gynecologist-turned-plastic surgeon had worked. Celebrrities such as Nya Lee of Love and Hip Hop notoriety as well as Mob Wives' Renee Graziano.
Needless to say, Robinson did not get the VIP regimen.
Instead of being catered to, she was stuck in a small wiating room with other patients while Shahine worked 24/7. The physician would keep the people waiting bby sedating them with tablets which were handed out by untrained staff. Robinson discovered, too late, that she would be operated on without an anesthesiologist and the only pain medicine would be Ibuprofen and a local application of skin-numbing ointment.
Shocked, Robinson demanded her money back. Shahine's response? He gave her another dosage of pills and in a few minutes, Robinson began to feel weak and sleepy.
Shahine boasts about his work on YouTube. He shows off the shape of a Brazilian butt lift and the breast implant surgeries he has performed -- all with just local anesthesia.
Robinson points to her drooping breasts and tummy bulges -- just two of eight areas which Shahine worked on in one 24-hour period and charged her over $14,000 in cash.
According to the New York State Health Department, Shahine has never had his operating room inspected, and his clinic has never been accredited as safe or sanitary.
All of the women involved now wish they had demanded more answers and examined Shahine before handing him the money. All have registered grievances with the authorities.
Ask Questions
Before giving any surgeon money, ask some questions:
- Are you a board certified plastic surgeon?
- How long have you been certified?
- Is your OR certified? By who?
- Do you hold any clinical privileges for this surgery?
To file a complaint, contact:
NY State Attorney General at 800-428-9071
NYC Department of Health at 866-692-3641, and
Manhattan District Attorney Complaint Line at 212-335-8900
Plastic Surgery Addict has "Rotting Nose"
A final word of warning. While some, about 5%, cosmetic surgery is justified because of disfiguring accidents, most is vanity.
A Brazilian steward, Rodrigo Alves, devoted his existence into morphing into a real-life Ken doll by plastic surgery. Recently, he was placed in a hospital after his latest nose began to decay on his face.
The 30-something, who is afflicted with body dysmorphic disorder, has handed over $400,000 on operations and is still "deeply unhappy" with his appearance. His unhappiness won't go away soon.
Alves has been found to have necrosis after noticing a small opening developing on his nostrils. Now, physicians think Rodrigo's face is in jeopardy of turning gangrenous if the affliction is permitted to spread.
Plastic surgery is one of the most trivial things in which people waste money. Unless you have a surgical need for reconstruction, there's really no reason to undergo this huge risk.