The alleged mastermind of what Los Angeles County prosecutors say is the largest insurance fraud scheme in the history of California remains at-large.

Dr. Munir Uwaydah

Dr. Munir Uwaydah has reportedly been out of the country since one of his former employees was arrested for murder in 2010. The Los Angeles County District Attorney's Office announced the 49-year-old surgeon was arrested in Germany on Sept. 9 and was awaiting extradition to stand trial on an alleged $150 million insurance fraud scheme.

But prosecutors said Tuesday that Uwaydah is not in custody in Germany and his whereabouts remain unknown.

"We were told by the appropriate authorities he was in custody," said Los Angeles County District Attorney's Office spokeswoman Jane Robison. She said she could not comment further.

Uwaydah was one of 15 people indicted by a Los Angeles County grand jury for allegedly paying fees to attorneys and others who referred patients to his Frontline Medical Associates clinics, performing unnecessary surgeries and allowing an assistant to operate on 21 patients.

An attorney who previously represented Uwaydah said at the time prosecutors announced the indictment and arrest that the doctor had not been arrested, but declined to comment further.

Meanwhile, a Los Angeles County judge on Sept. 25 called the allegations in the grand jury indictment "horrible" and made the transcript of the grand jury testimony available to the public, according to the Los Angeles Times.

During a Sept. 25 bail hearing, Los Angeles County Superior Court Judge Kathleen Kennedy said allegations included allowing a physician's assistant who had not gone to medical school to operate on patients without any oversight.

"Unnecessary surgeries by non-surgeons? That's pretty shocking stuff," the judge said.

Deputy District Attorney Dayan Mathai said the scheme appears to be ongoing, according to the Times. He said during the hearing that Dr. David Johnson's name was used to bill for a procedure purportedly performed on the same day he was arrested for his alleged role.

The Times also reported that Kennedy unsealed the grand jury testimony, providing more detail about patient complaints regarding procedures performed at Uwaydah's clinics. The article does not clarify whether the procedures were performed by Uwaydah or his assistant Peter Nelson, a defendant in the case who is alleged to have performed at least 21 procedures despite his lack of training.

One patient, Jennifer Milone, told the grand jury she awoke from a shoulder surgery in excruciating pain and after six weeks, she returned to the clinic thinking she had gangrene, according to the Los Angeles Times. A physician assistant said it looked like there was still a stitch in her skin.

But instead of removing a stitch, he pulled out 24 inches of gauze that had been left in her shoulder.

Milone said she complained to Uwaydah, who only apologized and said, "Sometimes things happen."

Milone said she didn't think she needed surgery, but agreed to the procedure after speaking with Uwaydah. 

She is not among the 21 patients identified in the indictment as having been operated on by Nelson.

Another patient, Kimberly Pope, said her shoulder surgery performed at Uwaydah's clinic resulted in an infected scar, according to the Los Angeles Times. Pope told the grand jury she called the workers' compensation insurance company and suggested it shouldn't pay for the procedure. 

The Times report did not identify the carrier or what, if anything, it did in response to Pope's complaint.

Pope said she filed a malpractice lawsuit against Uwaydah that she agreed to settle for $10,000. She said she was never paid.

The grand jury testimony also shows anesthesiologist Dr. Edgar Cosme testified about telling Nelson he was not supposed to perform a lumbar fusion. Nelson ignored him and operated for 25 minutes before Uwaydah came in to finish the procedure, according to the Times.

The patient in that procedure, who was not identified in the Times article, said the operation made him worse and left him unable to stand for long periods.