US Physician and Medical Practice Pay $3.8 Million to Resolve False Claims Act Allegations

It has been reported that Dr. Janette J. Gray of San Diego and her former medical practice, The Center for Health & Wellbeing in San Diego, have agreed to pay $3.8 million to settle allegations that they violated the False Claims Act by knowingly submitting false claims to the Medicare and TRICARE programs.

Dr. Gray and The Center claimed to operate an “alternative,” “integrative,” and “holistic” clinic, which was staffed by medical doctors, nurse practitioners, naturopathic doctors, chiropractors, acupuncturists, and mental health professionals, along with ancillary medical and administrative staff. Dr. Gray and The Center promoted IV infusion therapy, hormone/supplement therapy, and a variety of other alternative treatments.

The settlement resolves allegations that from 2012 to 2022, Dr. Gray and her practice billed Medicare and TRICARE for services that were not covered under either program by disguising the rendering provider, misrepresenting the services provided, “unbundling” services (by billing for a procedure or service in separate parts instead of a single code), or billing for services not medically necessary. In addition to paying $3.8 million to resolve the allegations, Dr. Gray will now be excluded from participating in Medicare, Medicaid, and all other Federal health care programs for five years.

“The civil settlement holds Dr. Gray and her former medical practice accountable for questionable actions that circumvented the TRICARE billing guidelines and allowed them to receive payments for services that should not have been reimbursed by TRICARE, costing American taxpayers millions of dollars,” said Bryan D. Denny, Special Agent in Charge of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Western Field Office.  “DCIS and its partners will always aggressively investigate those who defraud TRICARE, because those deceptive actions ultimately harm those defending our country and their families.”

“This investigation is proof that the FBI and its law enforcement partners remain committed to investigating and bringing to justice anyone who tries to violate the American health care system,” said FBI San Diego Acting Special Agent in Charge Houtan Moshrefi.

The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Southern District of California; the United States Department of Health and Human Services, Office of Inspector General; DCIS; and the FBI. This matter was handled by Assistant U.S. Attorney Maritsa A. Flaherty.

The resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477). The claims resolved by the settlement are allegations only, and there has been no determination of liability.

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False Claims Act?

I had never heard of it and thus looked it up:

The False Claims Act (FCA) is a federal statute that allows the government to recover money when someone submits false or fraudulent claims for payment to the government, including Medicare and Medicaid programs. It was originally signed into law in 1863 by President Abraham Lincoln during the Civil War to combat fraud by suppliers providing substandard goods and services to the troops. The FCA allows whistleblowers to sue entities defrauding the government and recover damages and penalties on the government’s behalf.

This sounds most reasonable to me, and it begs, I think, one question: why is it not applied much more frequently in the realm of so-called alternative medicine (SCAM)?