San Diego Clinic Settles for $3.8M After Decade-Long Medicare Fraud Allegations

A local physician and her previous clinic, The Center for Health & Wellbeing in San Diego, have settled for $3.8 million on accusations of submitting fraudulent claims to Medicare and TRICARE. The settlement, disclosed by the U.S. Attorney’s Office, addresses claims that extended over a decade, from 2012 to 2022.

The accusations focused on Dr. Janette J. Gray’s clinic, which promoted itself as a “alternative,” “integrative,” and “holistic” medical establishment. The practice engaged a variety of medical providers, including physicians, nurse practitioners, and mental health specialists. It focused on therapies like IV infusion and hormone/supplement administration.

Investigators charged Dr. Gray and her practice with multiple instances of fraudulent billing practices. These encompassed the misrepresentation of services rendered, the concealment of the rendering provider, the “unbundling” of services (billing for a single procedure as numerous distinct services), and the charging for medically unnecessary procedures.

Besides the cash settlement, Dr. Gray will be prohibited from engaging in Medicare, Medicaid, and all federal healthcare programs for the subsequent five years.

Read More; $744 SSI Payments Expected for Individuals Aged 18-64 in October; Check Key Details

U.S. Attorney Tara McGrath underscored the significance of honesty in healthcare, asserting, “When a physician commits billing fraud, we will safeguard patients and taxpayers from deception.”

The matter also attracted scrutiny from the Office of Inspector General of the Department of Defense. Special Agent in Charge Bryan D. Denny emphasized the substantial financial repercussions of the purported fraud, asserting, “This civil settlement holds Dr. Gray and her previous medical practice responsible for dubious actions that evaded TRICARE billing regulations, resulting in millions of dollars in losses for American taxpayers.”

Houtan Moshrefi, Acting Special Agent in Charge of the FBI San Diego, reaffirmed the dedication to combating healthcare fraud, highlighting the cooperative initiatives of law enforcement in tackling infractions within the healthcare system.

Reference