American Medical Systems, a major defendant in litigation over controversial vaginal mesh devices, is accusing “a pyramid of businessmen, doctors and lawyers” of luring women into unwarranted surgeries to remove the implants and inflate their damages claims.

The company, a unit of Ireland-based Endo International , has set aside $1.9 billion to settle as many as 49,000 lawsuits alleging injury from the devices, but it asserts it should not have to pay for unnecessary medical procedures.

Reuters previously reported that a new breed of financier is profiting from surgery on patients involved in litigation against mesh makers: These medical funders, often working through specialized brokers, put up the money for operations in anticipation of recouping their investment, plus a hefty return, when the patients’ lawsuits settle.

Now AMS says it has evidence that at least four women were persuaded to undergo surgeries that their own doctors did not recommend. Funding for their procedures was arranged by a lending company working with the doctors who performed them.

Hundreds more women may have been similarly steered into mesh removal procedures by a network of lenders, doctors and attorneys “orchestrating the exploitation of unsophisticated medical and legal consumers and seeking to perpetrate a fraud,” AMS said in a May 12 filing in West Virginia federal court.

Members of this alleged network deny wrongdoing. They say they helped injured women receive necessary medical care they could not afford or could not obtain from nearby doctors. They say AMS is trying to divert attention from its own liability for flawed devices.

AMS is seeking court authorization to obtain more testimony from members of the alleged network. A spokeswoman for Endo, which has ceased selling the mesh devices, declined to comment.

Calls From Telemarketers

One example cited by AMS is Judy Buzzell, who was implanted with a mesh device to treat urinary incontinence in 2009.

In 2014, according to Buzzell’s testimony, she received unsolicited phone calls from telemarketers who falsely said her device had been recalled by the U.S. Food and Drug Administration. The callers said they could find her a lawyer and arrange travel to a surgeon who would remove the mesh at no upfront cost.

AMS sought testimony from the doctor who implanted Buzzell’s device, who said that when Buzzell consulted him after the telemarketers’ phone calls, he found no mesh-related symptoms and did not recommend removal.

Buzzell testified that she decided to proceed anyway because she was experiencing pain and bleeding. Although she had health insurance, the telemarketer and another go-between helped her arrange a $21,000 advance from LawCash, a litigation funder, to pay for surgery and travel from her home in Maine to a doctor in Georgia.

According to her contract, which is part of the court record, Buzzell owes 39 percent annual interest, payable if her lawsuit settles. As of August, the total will be $46,500.

Based on AMS’s $1.9 billion fund and the number of eligible claims, the average amount available per plaintiff is approximately $39,000, although actual payments are confidential and vary based on individual facts.

“I’m screwed on it as far as paying it back, I know that,” Buzzell testified. “But for me to get rid of my pain that I wanted to get rid of, it was worth the trip down and back to get it done.”

Buzzell declined to comment for this story.

LawCash general counsel Lew Fidler said his company advanced money only to patients who “were desperate for surgery, needed surgery and complained about their circumstances.”

According to court filings, Buzzell’s surgery was arranged by another company that acted as a matchmaker between patients and doctors and received a commission from LawCash. Buzzell’s surgeon in Georgia, Michael Hulse, worked frequently with that intermediary, Surgical Assistance. Hulse received about $10,000 for Buzzell’s procedure.

Hulse did not respond to requests for comment. Blake Barber, who runs Surgical Assistance, said he encouraged women who contacted him for mesh removal surgery to first seek care from local physicians and use their health insurance.

AMS contends the heart of the “illicit enterprise” was a Florida-based marketing company that found potential mesh plaintiffs and supplied client leads to Surgical Assistance. The company, Law Firm Headquarters, bills itself as a “legal marketing and support organization.” As Reuters has reported, AMS subpoenaed Law Firm Headquarters, and several related law firms in March.

An attorney for Law Firm Headquarters, Abbe Lowell, said the company was trying to help women harmed by AMS’s products.

“(AMS’s) tactics will only delay resolution of these cases, to the further detriment of those who have been injured,” Lowell said.