An orthopedic surgeon has been sentenced to seven years for performing medically unnecessary X-rays to defraud Medicare and Medi-Cal.

Orthopedic surgeon gets seven years for medically unnecessary X-rays

September 09, 2022
by John R. Fischer, Senior Reporter
An orthopedic surgeon is behind bars for the next seven years for defrauding Medicare and Medi-Cal, the Medicaid program in California, by administering excessive and medically unjustifiable X-rays.

Between 2012 and 2016, Dr. Gary Wisner, who practiced in Lodi, subjected 10 patients to unnecessary exams during routine visits. He scanned multiple parts of the body, even when the patient’s condition did not require it, said California Attorney General Rob Bonta.

The California Department of Justice discovered the abuses while examining files from 26,000 individuals under his care. Wisner was convicted in June and sentenced in Sacramento Superior Court on September 2, reported The Sacramento Bee.

“Gary Wisner used both his patients and state resources to line his own pockets. Due to his dishonest behavior, patients at his clinic had to undergo unnecessary medical tests so he could steal from the state’s Medi-Cal funds,” said Bonta in a statement.

Because multiple government agencies suspected that Wisner was overbilling the Medi-Cal and Medicare programs, the state Justice Department’s Division of Medi-Cal Fraud and Elder Abuse worked with the U.S. Department of Health and Human Services, the San Joaquin County District Attorney’s Office, and the California Department of Insurance on the case against him.

The ten patients were randomly selected by the California Justice Department from all his patients in their investigation. Their files contained hundreds of unnecessary X-rays.

“This sentence reaffirms what we know to be true: Abuse of power by medical practitioners will never be tolerated within our state’s healthcare system,” said Bonta.

Wisner is also the subject of an independent criminal complaint filed by the San Joaquin County District Attorney’s Office for workers’ compensation fraud. That case is still pending.

The federal government and the state of California fund Medi-Cal. The Division of Medi-Cal Fraud and Elder Abuse received three-quarters of its 2021-2022 funding, a total of $50.5 million, from an HHS grant.

The Medi-Cal fraud division often relies upon whistleblowers to report fraud, but it was not specified if this was what led to the investigation into Wisner’s conduct.