D (3:54)

Delivered unnecessarily before 39 weeks?

C (3:57)

Yes, ma'. Am.

D (3:59)

When you started looking into this case, was there a point? Did you know right away this was some outrageous case because you knew there were so many complaints, or do you remember having a moment as you were looking through paperwork and investigating where you saw and understood the scope of this and had a moment to yourself like, wow, this is bigger than what I've seen.

C (4:20)

It's a far reaching case, especially because of the amount of patients that potentially were affected by Dr. Peruiz actions. As I mentioned before, he was a long standing physician in that area. So when you take that into account, even by his own words, he said he typically saw 4 to 5,000 patients a year. That's a pretty high patient base for a solo practitioner. So he was definitely seeing a lot of people. A lot of times we don't see health care fraud schemes that affect, especially when we're talking about patient abuse, potentially such a large pool.

D (4:55)

How did this come to your attention?

C (4:57)

It came to our attention in September of 2018. The FBI actually got a hotline complaint from an anonymous individual who claimed to be a nurse working in a facility. The nurse was concerned that there was unnecessary surgeries being performed specifically on Medicaid patients. And the anonymous complainant wanted to alert federal authorities to that. So FBI contacted our department, hhs, oig, where we all work together to quickly evaluate the situation.

D (5:33)

There were a number of scams alleged and prosecuted involving health care. You mentioned babies being delivered before they were going to be delivered or before they were really due to his convenience. What are some of the other overarching themes? Sure.

C (5:49)

Another area of particular concern would be he would tell a patient that they needed to have a certain organ removed, whether it was, say, your ovaries. However, when they'd wake up from the surgery, they had a hysterectomy instead. So he would frequently do something different than what the patient consented To So.

D (6:13)

You had surgery making a mistake or getting more money or were you able to figure out why?

C (6:21)

I believe he was doing it to get more money. And a lot of times one of the other areas that was particularly alarming, as well as he was pressuring individuals, specifically Medicaid patients who have. There's a rule in the Medicare program where you have to wait 30 days in order to have a sterilization procedure. He was pushing individuals to have sterilization procedures immediately, sometimes indicating that if they didn't, there was a chance they could get cancer. Not to worry, because sterilization is easily reversible, which most medical doctors will tell you that's not accurate. But he was telling his patients that. So what was happening is in order to get around the 30 day rule, he would actually have the individuals sign the consent form but leave the date blank. He would then provide the service within a couple of days of the consent form and go back and backdate the insurance form and submit it to the insurance company for payment.

D (7:24)

Another set of cases, I'll just describe a couple of examples. In a three day period in November 2017, per ways allegedly performed a diagnostic hysteroscopy, a colposcopy, a cold knife cone biopsy and a surgical hysteroscopy and caused an ultrasound to be performed. Then told the woman she had cancer and needed a hysterectomy and performed a supracervical abdominal hysterectomy. To support his claim, he falsely documented the hysterectomy was necessary due in part to her pelvic pain, bleeding and other factors. In truth, it says she did not have pelvic pain or any of the other symptoms and she did not have cancer and the surgery was not medically indicated, therefore unnecessary. That was just one. I mean, I kept going down the list. And there were other women that he told they had cancer and needed a hysterectomy or they would get cancer if they didn't have it. And none of that was true?

C (8:24)

Correct. That was one of his definitely very egregious actions. And talk about scaring people. As we all know, when you hear the word cancer, that sends off, you know, it sends off all sorts of alarm bells and fear. I don't think there's anyone out there that hasn't been touched by cancer. So to be intentionally scaring people into thinking you have cancer or intentionally misdiagnosing it is absolutely egregious. And one of the additional parts I can add and relate into the cancer diagnosis is at Times he would say that he was taking a biopsy. However, he wasn't frequently he was not actually taking biopsies or sending biopsies out to have them viewed. He was just telling you at cancer. Additionally, one of the procedures he was performing in order to help look for precancerous cells involved inserting a thin tube that had a light on it, an LED light. For all of 2016, the light did not work. If you imagine a tube being inserted inside of a person, it would be dark in there. The way the device is supposed to work is there's a camera and the lightens the area so that way you can see any abnormal cells or take a tissue sample, things of that nature. And the actual LED on his scope did not work.

D (9:48)

Do you have any idea how long this went on and approximately how many patients were defrauded?

C (9:54)

That's a difficult question. I can tell you that the indictment related to about 50 patients. Right after the arrest, the U.S. attorney's office, in conjunction with the FBI issued 24 hour crisis hotline. So that way individuals who were patients of Dr. Peruez could reach out to us and let us know. They fielded approximately over 500 calls to that nature. Additionally, we're talking, as I mentioned before, about 4,000 to 5,000 patients a year. And because he had been in the community for so long, there's a lot of patients out there, unfortunately.

D (10:34)

Were you able to quantify how much he defrauded the government or insurance programs?

C (10:41)

We ended up with a restitution amount of about $20 million. So that is what we estimate the loss was here that we could prove as well. This, like I said before, was an extremely egregious case. And while recovering $20 million of taxpayer funds is important, it really pales in comparison to stopping what he was doing to all these patients and women who maybe never will be able to have children because of his actions too.

D (11:12)

Was $20 million recoverable from him?

C (11:15)

It was ordered in the judgment.

D (11:17)

So we don't know if we got the cash.

C (11:19)

I know that 2 million was forfeited immediately. I do not know.

D (11:24)

And ultimately, would the women, some of the women victims, be getting some of that money?

C (11:30)

Our focus, you know, was on the investigation of arresting Dr. Perwaiz in which we moved, you know, extremely quickly to stop him. I hope that the victims feel some justice from the fact that he got a 59 year sentence and he's never going to get out of jail. He's been in custody since we arrested him in 2019.

E (11:57)

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C (12:03)

Santa.

D (12:03)

Santa.

C (12:04)

Did you get my letter?

E (12:05)

He's talking to you, Bridges.

C (12:06)

I'm not.

E (12:07)

Of course he did.

D (12:08)

Right?

E (12:09)

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E (12:30)

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C (12:34)

Nice.

E (12:34)

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D (12:59)

Can you describe what we will hear on the recording?

C (13:02)

Yeah, the audio recording that you're referencing is actually the interview of the doctor. So what happened? There is one of HHS special agents along with a special agent from Virginia Medicaid Fraud unit conducted an interview with Dr. Peruiz. Initially he volunteered to sit down. It was unannounced. They came to their office, his office and sit down and talk to the investigators. That's when he described some very simple background information, gave us an idea of his patient population. They asked a few additional questions related to procedures that are performed around that time. Dr. Perwaiz excused himself. He returned shortly thereafter and requested to speak to an attorney before he continued an interview with us, which at that point we ceased the interview. However, because of our concern about how dangerous we believed his actions were being based on what we felt was credible evidence we had developed specifically based on very intense patient interviews, speaking with former employees, the data review. He was an outlier in many data areas. We decided that it was important to move very quickly and we did a search warrant the following day. During the search warrant we took patient records. Some of his medical devices and tools along with appointment logs came to our attention shortly after the search warrant. So now he knows for sure that the FBI and HHS are looking at him. He continued to schedule surgeries, and due to the concern with patient harm, Department of Justice worked with us to do a complaint and warrant. Typically, in federal investigations, we go for an indictment first. We didn't do this in this case because of the time that would have taken. So we immediately got a warrant and we arrested him, and he was taken to federal court, in which case the judge remanded him to jail. So we took him off the street that day, and he hasn't been out since. He stayed in until his trial, in which he was convicted, and he remains in prison to this day.

D (15:19)

The length of time, maybe it went on longer, but we know about a decade that this fraud was committed. Does it strike you as. It strikes me as pretty odd that nobody told on him before then, because the list of what he did, if you look at what y' all laid out, it's so egregious and would seem so obvious, particularly if people in the hospital were naming them. Perway's babies, you know, had a name for these babies being delivered early. How come do you think it took. What does that say? That it took so long for somebody to notice or at least do anything about it?

C (15:54)

Well, I think what we need to focus on here is that as soon as we did get a complaint, meaning federal law enforcement, we moved fast. This became one of our number one priority cases because of the egregious allegations. But we get right out there. We were doing interviews, we were looking at data. We were talking to insurance companies because why. I have mentioned Medicare and Medicaid and federal programs along with Tricare. He also defrauded private health insurers as well. So we were reaching out to talk to them, find out if they had any information. So when it came to our level, we moved as absolutely quick as we could once we established these were credible allegations.

D (16:33)

Tell me, anything noteworthy that people might like to know about the trial. Did he testify?

C (16:41)

He did.

D (16:43)

Did he deny that he'd done anything wrong or that he knew he'd done things wrong?

C (16:49)

His. His testimony. You know, I've seen a couple of jurors who have been on, you know, television specials, and they say they were surprised he took the stand. But he did take the stand, and he denied some things he admitted to others. Ultimately, he was convicted. Whether or not his testimony, only he can know if his testimony was truthful or not.

D (17:10)

What was he convicted of? And how long did you say he'll be serving?

C (17:13)

He was served. He will serve 59 years in federal prison. He was 71 at the time of his conviction. So mathematically it looks likely that that's where he'll remain for the rest of his life. He was convicted on multiple counts of health care fraud, false statements related to healthcare matters as well.

D (17:35)

What would you say is a takeaway for people? We're going to tell this story about the case and I don't know what their takeaway is going to be, but what do you think it ought to be a takeaway ought to be?

C (17:45)

If you see something and it doesn't seem right, please say something. Hhs oig, the Office of Inspector General. We are completely focused on protecting patients and fighting fraud, waste and abuse in all of the federal healthcare programs. And this is a case where you're talking about an individual that was clearly working on a complex scheme. He was very manipulative in that he was, people say, almost too nice to his patients. And if you feel something just isn't right, if you're being pressured by your physician, which is how he got a lot of these patients to consent to things, scaring them, using words like cancer, saying, if you don't do this right now, you're going to get cancer. These type of things can be red flags. And I urge everyone, if you hear that, if you're working with a physician, it should be a teamwork. This, based on the interviews, this was not a teamwork. You and your physician should be a team to advance your health. And in this case, he wasn't looking to advance your health, he was looking to advance himself financially. So if you encounter a situation like that, ask questions. If they don't, your physician doesn't want to answer questions, which is one thing we did hear a lot about. Dr. Peruez, that can be a red flag. Your physician should want to talk to you. You should be open to ask questions. If you ask for a second opinion, professionals don't get upset by that. It's considered completely acceptable. So that's something too. If you're being pressured to do something or there is a diagnosis of cancer and you want a second opinion, ask your physician, let them know that that's something you're going to do. If they get upset, that could be a red flag, something you should be aware of. So I think the takeaway here is we encourage you to report something if you think it's suspicious. And that goes to members of the health care community, the general public, everybody, because we all need to work together. And just because you report it doesn't necessarily ultimately mean it's wrong. We're fact finders, we're going to look into it, but we can't, unfortunately, we can't be everywhere like we did here. As soon as we got news of it, we worked as fast as we could.

D (20:11)

Is a facet of this case still going on with the hospital being sued or potentially charged?

C (20:17)

All I can talk about today is Dr. Perwaiz. Because it's a closed investigation due to investigative integrity, I'm not allowed to speak about anything that may be an ongoing investigation within our agency. Okay.

D (20:31)

Is there anything else you'd like to mention that I left out?

C (20:36)

This was, as I mentioned before, one of the most egregious cases I have seen in my law enforcement career. It was just so far reaching and it's hard to believe that there was really an individual out there who was willing to hurt people for money. Additionally, one thing that was unique here that we don't see in all of our health care fraud cases anyways, was he was very careless with his patients and their health and their concern. However, his records were meticulous. He knew all the buzzwords to put in his patient charts. He would make up diagnoses, as you mentioned before, saying someone had back pain, he would change a hemoglobin level, maybe not record the accurate blood pressure, indicate the individual had some other complaints that they didn't have. But if you were to look at that record, especially from an auditing standpoint for a healthcare company, it would look like this was a completely justifiable service. The reality is his records are all lies. And you know, sometimes we even see healthcare providers that don't have records at all. So this was in contrast to things we've seen in the past. It was just really disheartening to see how he treated his patients, but then how well his paperwork was done in order to line his own pockets.

D (21:58)

It just strikes me that must have been a really tough part of the investigation to prove that what he wrote down was wrong contemporaneously because you didn't know necessarily what the person's blood pressure was on that day. So how do you, you had to figure out how to match what he wrote down and show that that wasn't accurate.

C (22:14)

That's correct. We relied extremely heavily on patient interviews here. And because of the nature of the procedures being done, the personal nature, the patients were very aware and able to provide details. Patients were definitely upset when they looked at their chart and saw that they, you know, we're supposed to have had, you know, heavy menstrual bleeding or back pain and things. And they never had any of that stuff. And they were very adamant that they had it. And from the data perspective too, there were some procedures that he was such an outlier. He did approximately 86 to 87 procedures over a two year span in which the next provider in the state of Virginia, which is a large state, conducted six of the same procedures in their office. And that just that number just pops out at you.

B (23:16)

The full story on December 21st Sunday, including an interview with one of Dr. Perwaiz's victims. You can find listings of times and stations where Full Measure airs on Sundays by going to Cheryl Atkison.com and clicking the Full Measure tab. Or you can always if it's easier for you, watch online at FullMeasure News. On Sundays, the whole show feeds around 10 o' clock in the morning Eastern Time at FullMeasure News. Replays are posted there thereafter. There are also replays on our unadvertised YouTube channel, full measure with Cheryl Achison. I hope you enjoyed today's podcast and that you will check out my other podcast, the Cheryl Achison Podcast. Leave us a great review. Consider sharing this with your friends and subscribe. As always, you can help support independent journalism by purchasing a copy of my bestseller Follow the How Big Pharma Misleads, Obscures and Prevails. Or Visit the Cheryl Atkison store for some unique products. Go to cherylakisson.com and click the Store tab. Proceeds support projects like the Independent ION Awards for Investigative and Original News Reporting, Cash awards that I give at some colleges and also to professional journalists to encourage the kind of reporting I know you appreciate, but too often does not get well recognized in today's managed news environment. Do your own research. Make up your own mind. Think for yourself.