NORFOLK, Va. – Javaid Perwaiz, the gynecologist whose federal trial on 61 counts of fraud opened Oct. 14, 2020, in federal court here, had a singular way of writing dates on patients’ charts. Rather than use slashes between numbers, he used dots.
On a consent form authorizing him to sterilize a woman in July 2016, those three dots dated her signature to June 16, 2016, more than the required 30 days before surgery under Medicaid rules.
The signature was hers, but she didn’t write that date. Perwaiz did, a prosecutor said. He first saw the woman only five days before the procedure, Rebecca Gantt, an assistant U.S. attorney, said in her opening statement. It was just one of many instances, she told jurors, when Perwaiz, 70, manipulated records to cover crimes that enriched him but endangered pregnancies, sterilized women unnecessarily and pressured them into needless procedures to finance his lavish lifestyle.
The dots also showed up on the chart of a pregnant patient, moving up her due date by a week in 2019. The woman was induced in her 38th week when there was no medical reason to do so, Gantt said. Why? So Perwaiz could induce the pregnancy on a Saturday, when he regularly performed so many rounds of surgery that the staff at a Chesapeake hospital had difficulty keeping pace, Gantt said.
“This is a case about broken trust, manipulation and greed,” Gantt told 12 jurors and five alternates.
But Lawrence Woodward Jr., an attorney for Perwaiz, portrayed the doctor as beloved by thousands of patients over four decades. “They’re bringing to you 25 or 30 cases out of tens of thousands,” he said in his opening statement. “Many patients were with him for years, even decades, after the surgeries.”
If he had a high number of surgeries it was because he worked hard, Woodward said. Why didn’t hospitals and insurers question the numbers, he asked.
Perwaiz never married. He rarely traveled.
“He is the hardest-working doctor you ever saw,” Woodward told jurors.
As she laid out the government’s case, Gantt agreed that patients trusted Perwaiz. But she said he used that trust and the fear of cancer to coerce them into surgeries, including sterilizations. They went to his main office in Chesapeake without any complaints and left with an appointment for a hysterectomy the next weekend after Perwaiz told them they were precancerous, Gantt said. His staff was encouraged to rush patients into surgeries because he feared they would change their minds, she added.
“He tricked his patients into having a hysterectomy,” Gantt said.
One woman who underwent a hysterectomy in September 2019 to avoid what Perwaiz told her was a cancer danger, still cannot use the bathroom normally, Gantt said.
“He pushed patients to have irreversible surgeries they did not need,” Gantt said, adding that the prosecution will ask the jury to determine that Perwaiz caused “serious bodily injury” to patients.
Woodward pushed back against the allegations that the doctor used unfounded threats of cancer to pressure women into surgery.
Different doctors, he said, treat the threat of cancer differently, and Perwaiz was one of those who was more aggressive.
“Dr. Perwaiz doesn’t make cancer scary,” he added. “Cancer is scary.”
Prosecutors also allege that Perwaiz billed health insurers hundreds of thousands of dollars for phantom medical procedures. He charged for hysteroscopies, a procedure used to view a woman’s uterus, during times when the scope was broken or he did not have the other materials in his office to perform the procedure, Gantt said. He billed for colposcopes, a procedure to view the cervix, she added, and wrote abnormal findings on patients’ charts even though he didn’t use the solution that would allow him to see those abnormalities.
While the individual insurance payments were relatively low, Perwaiz tallied so many of them that Gantt said he collected for “hundreds of thousands of dollars for hysteroscopies and colposcopes that he did not do.”
Between 2010 and 2019, Perwaiz billed insurance companies more than $2.3 million for gynecological care partly justified by diagnostic procedures he never performed, prosecutors allege in the indictment. The indictments cover 25 patients, most of whom he saw from 2015 to 2019.
Prosecutors have not said how many others they think were victims. So many women came forward after his arrest in November that the FBI created a website about the case for them. Malpractice suits also are pending against Perwaiz, who had two offices in Chesapeake, south of Norfolk, and privileges at Bon Secours Maryview Medical Center and Chesapeake Regional Medical Center.
Perwaiz, who is jailed without bond, pleaded not guilty. He has not spoken publicly about the charges. The trial is expected to take a few weeks.
“This is a large and far-reaching scheme, but what the defendant did was simple,” Gantt said. “He said things that were not true to make money.”
During the decade covered by the indictments, Perwaiz lived lavishly, purchasing a pair of Mercedes-Benzes, a Jaguar, a $4,000 fur coat and a $1,000 pen.
Perwaiz first became an OB/GYN and established his private practice in 1982. State records show he allegedly performed 11 hysterectomies on women that year without a medical reason. Maryview Hospital fired Perwaiz, citing “poor clinical judgment, unnecessary surgery, lack of documentation and discrepancies in recordkeeping,” the records show, but the Virginia Board of Medicine, which had the power to revoke or suspend his license, chose to censure him – chastising his bad note-taking and condemning his “lack of judgment” for engaging in a sexual relationship with a patient.
In 1996, Perwaiz was convicted of tax fraud. He briefly lost his license before it was reinstated. The indictment also alleges that the doctor made false applications to health benefits providers, failing to disclose his felony conviction.
Woodward called the document issues “paperwork mistakes,” not part of a fraud scheme. “The issue will be,” he said, “is he a scam artist?”