Beverly Hills plastic surgeon accused of performing surgeries as part of insurance fraud scheme – Story

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– A well-renowned plastic surgeon with private practices in Beverly Hills and Newport Beach is accused of performing unnecessary surgeries on patients as part of an insurance fraud scheme, as well as allowing the USC residents and fellows he trains to operate on his private patients without their consent, according to a newly filed lawsuit.

Dr. Jay Calvert trains USC affiliated fellows through a fellowship program called the Marina Rox Aesthetic Surgery fellowship, which USC confirms it sponsors academically.

On Calvert’s LinkedIn page, he identifies himself as an associate professor at USC’s Keck School of Medicine, teaching surgery and rhinoplasty to USC residents and fellows.

USC tells FOX 11 Calvert’s description is inaccurate, and that he only serves as voluntary faculty for the university.

On USC’s website, Calvert’s name appears as a faculty surgeon, and his “state of the art” Beverly Hills practice is listed as the location where USC residents and get hands-on training.

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Natalie West tells FOX 11, she believes she was a victim of that training.

“The only reason I’m doing this interview is to save people who would go to him,” West said. “I’m terrified, it’s the biggest nightmare that you could ever imagine.

West is one of Dr. Calvert’s former patients, now suing Calvert and USC for fraud, and medical battery.

West’s story begins in 2013, when she says she paid Dr. Calvert $24,900 out of pocket for a cosmetic rhinoplasty to fix the tip of her nose after a previous accident.

“After the first surgery, it looked good, I was happy with it,” she said. “But he convinced me to go back, he said ‘Oh, it’s just two easy tweaks.”

West says Calvert told her he just needed to do a couple of minor procedures to allegedly “perfect” the results, but she says, she was brought back for many more than that.

According to her lawsuit, “West would undergo approximately 12 additional surgeries or medical procedures, including multiple unconsented procedures, many of which were actually performed by USC students, residents, or fellows, rather than by Calvert himself.”

“I don’t know what was done to me, and it was like a continual come back, I’ll fix it, come back I’ll fix it,” West said. “Every time I would go back to get it fixed, it got worse.”

West told FOX 11 her follow up surgeries at Calvert’s practice went through 2017, only paying for the surgery room, and anesthesia each time, as she said Calvert told her the revision surgeries would be free of charge given she had already paid him cash for the primary surgery.

But West alleges that after each surgery, more damage was done. She says her nose began to fill with fluid, she had to be on daily IV for some kind of allergic reaction, she believes some kind of unknown material was placed in her nose, and she says the pain became unbearable.

“It felt like I was drowning in my own head,” West said.

West told FOX 11 she was flabbergasted after she says Dr. Calvert’s front desk told her a USC fellow did one of her surgeries instead of Dr. Calvert.

“She said [name redacted] is the one that did your surgery, and it was his last surgery before he finished his fellowship,” she said. “I was like what are you talking about, why was he doing the surgery?”

West provided FOX 11 with the prescription for her painkillers after the surgery, showing they were prescribed by the USC fellow, instead of Dr. Calvert.

“Calvert never once mentioned anybody training with him, not one time,” West said.

“The trauma and pain he has put her through is inexcusable,” said Leslie Hakala, the attorney representing West, and another former patient of Dr. Calvert’s.

“They had no idea they were being operated on by anyone other than Dr. Calvert himself, but in fact they were, without their consent.”

West says she eventually had to go to another surgeon to remove the material she says was put into her nose.

“It wasn’t anything about how I looked, it was about the poison, and that’s all I could call it was a poison because it hurt so bad” she said while tears streamed down her face.

West told FOX 11 all of her nose surgeries with Dr. Calvert were elective, cosmetic surgeries, meaning they’re not covered under insurance.

But according to her lawsuit, she discovered that Calvert had fraudulently billed her insurance over $520,000 and fraudulently collected over $330,000.

“I found out he got paid an outrageous amount of top of the cash I paid,” West said.

On top of accepting Wests $25,000 in cash for her first nose job, documents show Calvert also billed her insurance $58,000 under Roxbury Clinic, about $32,000 under Calvert M.D. Inc., and about $8,000 under Roxbury Surgical Associates.

Records from the state of California show Calvert is the CEO and president of all three of those entities.

“It was just like my insurance was his personal ATM card,” West said.

West provided FOX 11 with numerous documents from her insurance provider which she says shows Dr. Calvert repeatedly billed her insurance tens of thousands of dollars at a time for her surgeries,despite being cosmetic in nature.

“For Dr. Calvert to bill her insurance company over and over again, both in his own name and in the name of his surgical associate group, the name of his clinic, and so on, for hundreds of thousands of dollars, is inexcusable,” Hakala said.

Hakala alleges that Dr. Calvert’s operative reports show he routinely falsely diagnosed West with nasal airway obstruction. She claims this was a scheme to portray West’s surgeries as medically necessary to her insurance so he could bill them.

“That was never a diagnosis she was told about, and as far as she knew, she never had,” Hakala said.

“I didn’t go to Calvert for airway obstruction, I never talked to him about airway obstruction, every surgery I went for was cosmetic,” West said.

According to West’s lawsuit “Calvert’s office pressures new patients to provide their health insurance information, only to misuse it to perform or allow unnecessary and unneeded sinus procedures, turbinates procedures, and other procedures covered by insurance with eh specific intent to wrongfully bill insurance carriers.

“It’s hard to believe that any competent doctor, not just trying to bill, would need to go back 13 times and still not be able to solve a patient’s problems,” Hakala said.

Calvert declined an on camera interview with FOX 11, but his attorney, Arthur Barens, provided the following statement: 

“Every procedure performed by Dr. Calvert on every patient was consented to in writing prior to the procedure by the respective patient,” Barens said. “Dr. Calvert has never allowed or permitted any resident or fellow to perform surgery on his patients which is verified by patient medical records. This case will be vigorously defended and ultimately rejected by the court.”

“I am afraid of Jay Calvert, I am, and I’ve got good reason to be, because he did threaten me,” said Michael Houston.

Houston is also a former patient of Dr. Calvert’s.

He alleges Calvert falsely diagnosed him with nasal airway obstruction several times, including in an operative report for a rhinoplasty, which he accuses Calvert of fabricating.

In it, Calvert writes that a box fell on Houston’s nose, collapsed his left nasal bone, and he developed an airway obstruction.

“That’s not true, that’s blatantly easy to expose, that’s not true,” Houston said. “There was no accident, there was no box,I didn’t like the way my nose looked.”

Houston says his insurance documents show Calvert billed his provider over $150,000 for that surgery.

Houston tells FOX 11 he also wanted a more masculine jawline, so he went to Dr. Calvert for jaw implants.

“He said if you allow me to film it, there’s no charge,” Houston said.

He says Calvert falsely diagnosed him with a jaw contour deformity, and when the jaw implants ended up being too big for his face, they had to be removed, which he says was billed to his insurance for over $20,000.

Houston says he also went to Calvert for chest implants, which had to be revised twice, as well as a breast reduction and multiple liposuction surgeries..

“I’m too lazy to go work out, and he billed my insurance over $100,000 for that liposuction,”

Overall, Houston says Calvert billed his insurance more than $700,000 in total on multiple surgeries that had no medical necessity.

“These were cosmetic surgeries I went to Dr. Calvert for,” he said. “They should never have been billed to the insurance company, this is just blatant fraud.”

And Houston says when he questioned Calvert on it, he was threatened.

“He said look, if I go down for insurance fraud, I’m taking you with me, so I wouldn’t push the issue,” he said.

Calvert’s attorney declined to respond to Houston’s allegations when asked for a comment by FOX 11, and it’s not the first time Calvert has faced allegations of fraud.

In 2013, Calvert was charged with multiple felonies in Orange County after he was accused of fabricating documents and performing unnecessary surgery as part of an insurance fraud scheme.

In 2014, prosecutors dropped all charges against him, after they say Calvert agreed to pay restitution, and agreed to change his billing practices.

In an interview with the Orange County Register, the deputy district attorney on the case said “We’re not dealing with a situation of me dismissing the case because he’s innocent.

The reason it was done was it appeared to be a reasonably isolated incident. But is the answer a felony conviction that could jeopardize his license? Under the circumstances, the fact that he met me halfway, I decided to give him a break.”

FOX 11 contacted the DA’s office to see if they still stand by the statement that Calvert was not innocent.

They said they do.

Now, five years later, Calvert’s former patients say, history is repeating itself.

“Doctor Calvert should not be working on anybody with what he’s doing to his patients,” West said.

“I don’t know how Calvert got so greedy, or how he’s been able to get away with what he’s done for so long,” Houston said.

USC provided the following statement to FOX 11 in response to this story” 

“Dr. Jay Calvert is a voluntary faculty member at the Keck School of Medicine of USC. He has not been appointed to the regular faculty, nor has he been employed by or compensated by the University.

Keck School of Medicine of USC is the academic sponsor for a fellowship program run by Dr. Jay Calvert. It is important to note that the fellowship program is independent of the University and endorsed by the American Society for Aesthetic Plastic Surgery (ASAPS). The University is not involved in any patient billing for the fellowship or Dr. Calvert’s practice. The benefit of the University’s academic sponsorship of the fellowship program is to provide fellows access to the Keck School of Medicine online library and academic lectures. Aside from this access, fellows in this program are not associated with the University.”

(Excerpt) Read more Here | 2019-05-14 07:12:57
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