Insurance Fraud NEWS
Suit: Nose job billed to California patient’s insurer
May 14, 2019, Beverly Hills, CA
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.
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
Source: FOX 11