Over and over, Perwaiz frightened women into invasive, and at times irreversible, procedures, far outpacing his colleagues. He used the threat of cancer as a scare tactic and is accused of basing his decisions on exploratory procedures with potentially broken equipment.
The reason, authorities say, was to make more money.
In court documents filed in U.S. District Court in the Eastern District of Virginia last week, federal officials claim the 69-year-old doctor has been falsifying medical records since at least 2010 to justify medically unnecessary procedures on female patients in a scheme to defraud Medicaid and the Blue Cross Blue Shield Federal Employee Program.
Perwaiz, who has been practicing medicine in Virginia since the 1980s, was arrested Nov. 8 on one count each of health-care fraud and making false statements relating to health-care matters. Still wearing his green scrubs, Perwaiz appeared that afternoon before a federal magistrate judge in U.S. District Court in Norfolk, where another hearing was scheduled for Nov. 14, reported the Virginian-Pilot. He is being held without bond.
His attorney did not immediately respond to a request for comment.
This is not the first time Perwaiz has been under investigation.
In 1982, he lost hospital privileges at Maryview Hospital in Portsmouth, Va., — now under new ownership as Bon Secours Maryview Medical Center — due to “poor clinical judgment and for performing unnecessary surgeries,” according to court documents. He was investigated by the Virginia Board of Medicine for performing surgeries — mostly hysterectomies — “without appropriate medical indications and contrary to sound medical judgment,” the documents said. In 1996, he pleaded guilty to two counts of tax evasion, and his medical license was temporarily revoked. He got it back in 1998.
In at least eight malpractice claims, Perwaiz has been sued and accused of falsifying patient records to justify medical procedures, using unnecessarily invasive techniques and performing as many as 30 procedures in one day. The malpractice suits also allege that his substandard care caused irreparable, permanent injury to three patients and life-threatening injuries to two patients, according to court documents.
The most recent investigation began in September 2018, when the FBI received a tip from hospital employees who suspected Perwaiz was performing “unnecessary surgeries on unsuspecting patients.”
Perwaiz has two offices in the town of Chesapeake, which sits south of Norfolk on the Elizabeth River. He is affiliated with Bon Secours Maryview Medical Center and Chesapeake Regional Medical Center, reported the Pilot.
Perwaiz’s website says his “surgical skills are unparalleled,” and he is “dedicated to the promotion of healthcare to women from adolescence to menopause and beyond.”
Yet in charging documents, witnesses described an environment in which hospital staff had a hard time keeping pace with Perwaiz as he rushed from procedure to procedure. Patients often did not know what kind of procedures they were undergoing, federal officials allege, and women were subjected to “annual cleanouts."
From January 2014 to August 2018, investigators found that Perwaiz performed surgery on 510 patients who receive Medicaid benefits — which meant 40 percent of all his Medicaid patients went under the knife. Of those 510 patients, about 42 percent had two or more surgeries.
According to court documents, Perwaiz would perform more than one surgery at the same time, including laparoscopies, which involves inserting a fiber-optic instrument through the abdominal wall to see the organs; dilation and curettage, which involves opening the cervix and inserting a thin instrument into the uterus to remove tissue; and lysis of adhesions, which is a surgery to remove tissue, often scar tissue from a previous procedure.
Charging documents allege Perwaiz’s volume of in-office hysteroscopies far outpaced that of his colleagues. In fiscal year 2016, he performed 86 of them, and in 2017 he performed 87. The next leading provider performed six hysteroscopies in the same time frame.
A hysteroscopy involves inserting a thin, lighted tube into a person’s vagina to examine the cervix and uterus. Often, it helps determine the need for additional treatment, including surgery. But according to charging documents, witnesses told authorities that Perwaiz’s procedures lasted five to 10 seconds — an insufficient amount of time to properly insert the scope in the cervix and inspect the uterus.
Those in-office hysteroscopies, authorities said, were “improperly performed and were of little or no diagnostic value.”
It’s possible the equipment Perwaiz used did not even work. According to inspection paperwork from 2010, the doctor’s scope was badly damaged — so much so that a third party contractor said the instrument was “completely broken.” It was repaired and returned, according to charging documents, but had not been serviced in the nine years since.
The Virginia Medicaid Department of Medical Assistance Services (DMAS) found that Perwaiz was an outlier not only in the volume of hysteroscopies he performed, but also in the number of gynecological surgeries. According to charging documents, he swapped in boilerplate language to describe patient symptoms on paperwork that could set precedent for a procedure — even if the symptoms didn’t match their experience.
Apart from the woman whose fallopian tubes allegedly had been burned, court documents recount the specific cases of three other patients.
In January, a 25-year-old female patient of Perwaiz’s went to the emergency room at a hospital in Suffolk, Va., with heavy and prolonged menstrual bleeding. She later received blood transfusions and an injection to help stop the bleeding, authorities said. Her doctors said the cause was not fibroids.
But at a follow-up appointment with Perwaiz, he told her the opposite — despite normal ultrasound results, authorities said. He mischaracterized her symptoms in her medical chart, writing that she was experiencing bleeding when she was not, and said she needed a D&C procedure to remove fibroids. She agreed to have the surgery.
Six months later, fearful that the fibroids Perwaiz said she had were growing back, the woman returned to the doctor’s office. Once again, she was not bleeding, but Perwaiz’s chart notes say she had complained about just that. She underwent another ultrasound, which was normal, yet Perwaiz told the patient and wrote in her chart that she needed an invasive surgery to remove “uterine fibroids.” He had also encouraged her to have a hysterectomy, according to charging documents, a procedure he had performed on her mother, sister and cousin.
When the woman questioned the validity of such an invasive procedure, which would have required her to miss work for a week, Perwaiz told her she had “big tumors” that needed removed but that she could cancel the procedure if she wanted.
In another case from September, charging documents allege that Perwaiz convinced a 56-year-old patient who was experiencing postmenopausal vaginal bleeding to have a hysterectomy — even though two other doctors had suggested less drastic solutions. He documented symptoms, including pain and cramping, that the patient denied experiencing. In her surgical charts, he wrote that she had requested the hysterectomy, though the woman later told authorities that was untrue.
She said she did not want a hysterectomy; Perwaiz told her it was her best option, according to charging documents.
Perwaiz also used the “C-word” — cancer — to scare patients into surgery, witnesses told authorities.
One patient sought treatment from Perwaiz after an abnormal Pap smear. She had previously undergone a mastectomy after a diagnosis of Stage III invasive ductal carcinoma, an aggressive form of breast cancer. After additional Pap smears and a cervical exam, the woman was “led to believe” by Perwaiz that “precancerous cells were detected and that onset of cancer was imminent,” according to court documents.
Perwaiz recommended a hysterectomy, but the woman objected to such an invasive procedure. She believed the two had agreed upon an outpatient laparoscopic surgery to remove her ovaries alone. When the woman awoke in recovery, she was “shocked” to learn her abdomen had been cut open and her uterus was gone, authorities said.
During the alleged nonconsensual procedure, Perwaiz had also perforated her bladder. She developed sepsis and was hospitalized for six days.
She later got copies of her medical records, authorities said. In them, there was no mention of “precancerous cells.”
Clarification: A previous version of this story stated that Perwaiz lost his hospital privileges at Bon Secours Maryview Medical Center in 1982. At the time, the medical center was called Maryview Hospital. It was later purchased by Bon Secours and the name was changed.