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Liability and Duties of Third-Parties: On Spyros Panos and Issues Concerning Medical Examiner Fraud in Relation to Workers’ Compensation Claims

August 6, 2018

Workers’ compensation insurance providers continue to deal with the fallout of the actions of Dr. Spyros Panos, who is charged with committing health care fraud by conducting medical/utilization reviews on behalf of insurers, without a license and while using a stolen identity, primarily in New York and Connecticut. Panos, a previously convicted felon, was arrested in April 2018 for a second time and charged with numerous crimes, including health care fraud and aggravated identity theft.

The Panos case presents novel issues for the workers’ compensation insurance community. While most recent cases of fraud involve claimant providers, Panos was acting on behalf of insurance carriers, and was already unlicensed in New York. This set of circumstances appears to be one of first instance in New York, and it remains difficult to anticipate exactly how widespread the fallout will be. Any investigation of fraud will be conducted by the New York Inspector General, and is outside of the jurisdiction of the Workers’ Compensation Board. Unresolved questions include what actions carriers and third-party administrators should take to mitigate potential liability, and how far liability might extend to third parties.

Goldberg Segalla’s Workers’ Compensation Practice Group has fielded numerous questions related to the Panos case, and has published a white paper taking a closer look at many of the case’s most pressing issues for insurers and third-party administrators.