“Yes, I knew the 30-day requirement. I just couldn’t say no,” he said from the witness stand Thursday. “I’m an advocate for my patients.”
He said he performed the sterilizations in contradiction to the requirement to benefit his patients. Often, they had discussed sterilization with doctors who referred them. They told him, he testified, that their insurance would run out if he waited or that they could not get a ride or a babysitter on other dates. Asked during cross examination if he could name which of the patients in the indictments told him that their insurance was running out, Perwaiz could not.
Backdating forms is part of three broad categories of charges against Perwaiz. Prosecutors say he altered medical records to justify unnecessary surgery, often scaring women by mentioning the threat of cancer. They allege he changed due dates so he could induce women into labor on the Saturdays he was operating on other patients at Chesapeake Regional Medical Center. And they contend he billed insurers for office medical procedures done with broken equipment.
He is also charged with falsifying his application to health-care providers by omitting a felony conviction for tax fraud in 1996, which resulted in a brief suspension of his license, and failing to admit his loss of privileges at Maryview Hospital in 1983. Perwaiz, 70, has been jailed since his November arrest.
In a full day of testimony, Perwaiz, led by defense lawyer Emily Munn, defended the care he gave to the two dozen patients named in the 61 counts against him. In case after case, she broadcast his medical charts and the form he filed with Chesapeake Regional Medical Center before surgery. The charts were identified by the initials of the women prosecutors charge he operated on unnecessarily — D.B., D.P., A.G., T.D.C., A.F., A.N. S.N., D.B.D — and by their age and the complaints they wrote down, which several women who testified previously said were false.
In case after case, Perwaiz explained that the complaints by the women — often pelvic pain, bleeding and cramping — justified his procedures. Often, he said, women asked him to be sterilized. In none of the cases of women named in the indictments, Perwaiz said, did he refer them to other doctors after finding evidence of cancer.
During cross examination by Elizabeth Yusi, an assistant U.S. attorney, Perwaiz said due dates for patients were changed not for his convenience so he would be paid for the deliveries, but because he relied on a “range” of possible dates from several ultrasound examinations. The American College of Obstetricians and Gynecologists and Chesapeake hospital guidelines advise against inducing labor before 39 weeks without a medical reason, saying it leads to health problems for the baby. Chesapeake Regional Medical Center prohibited inducing labor before 39 weeks without a medical reason.
Perwaiz said his own research indicated no reason for that policy. “There is no difference in immediate morbidity and mortality” he told Yusi. “I find it not understandable that we enforce
The surgeries started that year and ended only in 2015. Each time, her handwritten medical chart reported that she had complained of pelvic and back pain, bad cramps, frequent and long periods, or something growing in her vagina.
The woman was asked whether she had ever suffered those symptoms. “I never said that,” she answered again and again. She was the latest of Perwaiz’s patients to share their experiences with a doctor prosecutors say performed unnecessary procedures over the course of a decade as part of a scam to fund his lavish lifestyle.
Perwaiz faces 61 fraud counts that cover 25 patients, most of whom he saw from 2015 to 2019. Prosecutors have not said how many others were victims. So many women came forward after his arrest in November that the FBI created a website about the case for them.
When the patient asked Perwaiz why she needed surgery, she said he replied that there was an abnormal growth in her uterus that could be cancer. “I was told this lump will keep on growing each time it was removed,” she testified. “If I do not take care of this, then it would spread very rapidly and cause cancer.”
He operated in 2006, 2007, 2010, 2012 and 2015. During the 2012 surgery, he performed a hysterectomy, removing her uterus and left ovary but leaving her right ovary intact. In 2015, according to her testimony, she voiced no complaints during her checkup, but Perwaiz told her she needed another surgery. This time, he removed her remaining ovary.
Each time he told her that surgery was necessary, she believed him. “He’s my doctor,” she told jurors. “I have to trust him.” M.C. was among the patients who testified that they trusted Perwaiz when he told them they needed invasive procedures over the years.
Like patients, health insurers also trusted him.
He billed them hundreds of thousands of dollars for phantom medical procedures, according to his indictment.
He billed for hysteroscopies, a procedure used to view inside a woman’s uterus during examinations, during times when either the scope was broken or he did not have the other materials in his office to perform the procedure, prosecutors allege. They contend he billed for colposcopies, a procedure to view the cervix, and wrote abnormal findings on patients’ charts even though he didn’t use the solution that would allow him to see those abnormalities. And they say he billed for unnecessary hysterectomies.
Prosecutors also contend that Perwaiz often induced labor for pregnant patients before they were due on Saturdays at Chesapeake Regional Medical Center, where he scheduled surgeries, so he could earn money making deliveries.
Between 2010 and 2019, Perwaiz billed insurance companies more than $2.3 million for gynecological care partially justified by diagnostic procedures he never performed, prosecutors allege in the indictment. In testimony earlier in the trial, an investigator for Anthem Blue Cross Blue Shield said that, over a decade, more than 41 percent of Perwaiz’s patients had surgical procedures compared with 7.6