After a two-week trial, a jury in the Sacramento County Superior Court found Gary R. Wisner, M.D., an orthopedic surgeon in Lodi, California, guilty of ten felony counts of healthcare insurance fraud.
Orthopedic Surgeon Found Guilty of Healthcare Insurance Fraud
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Secondary#medicaid#medical
Dr. Wisner operated a California-based orthopedic surgery and spine surgery clinic. The healthcare fraud charges involved false and fraudulent claims made to both Medi-Cal, California’s Medicaid program, and Medicare. According to the California Department of Justice press release, from 2012 to 2016 Dr. Wisner defrauded both Medi-Cal and Medicaid by “administering excessive and medically unjustifiable X-rays to his patients.”
Officials at the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse were first notified of Dr. Wisner’s suspected fraud in late 2016. The investigation revealed that Dr. Wisner, per the press release, “would administer X-rays even in routine office visits and would X-ray multiple parts of a patient’s body—regardless of whether it had any relation to a patient’s medical condition.” During the trial it was revealed that “over the course of an approximate four-year period, Wisner subjected ten individual patients to hundreds of unnecessary X-rays at his clinic.”
Dr. Wisner faces a state prison sentence.
In the California Department of Justice press release, Attorney General Rob Bonta commented, “When medical practitioners abuse their power, it’s always at the expense of patients under their care. Gary Wisner abused the position he held as a healthcare provider by subjecting his patients to unnecessary procedures to secure additional profits.”
Bonta continued, “I want to express my gratitude to the San Joaquin County District Attorney’s Office who aided us throughout the course of this investigation. The California Department of Justice and our law enforcement partners will continue to hold accountable those who attempt to use the Medi-Cal program for personal gain, and to safeguard those it serves.”
A separate criminal complaint has also been filed by the San Joaquin County District Attorney’s Office against Dr. Wisner. The complaint, which is still pending, alleges worker’s compensation fraud. Dr. Wisner is presumed innocent until proven guilty of those charges.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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