Former North Alabama doctor and wife plead guilty to health care fraud charges
www.whnt.com, Rebecca Teutsch, June 10, 2024
HUNTSVILLE, Ala. (WHNT) — A North Alabama doctor and her wife pleaded guilty to multiple health care fraud charges, according to the U.S. Department of Justice.
In 2022, Francene Aretha Gayle and her wife, Schara Monique Davis were both charged with conspiracy to commit health care fraud and wire fraud.
On June 10, Gayle pleaded guilty to five counts of unlawful drug possession, one count of health care fraud conspiracy and one count of wire fraud conspiracy. Davis also entered a guilty plea for one count of health care fraud conspiracy and one count of wire fraud conspiracy.
The defendant’s plea agreement states that between 2014 and 2022, Gayle was the sole physician at a multi-clinic practice across three north Alabama locations: Huntsville, Athens and Killen. Davis owned the company and served as the business manager.
In 2019, records show that the Killen location was shut down. The Alabama Medical Licensure Commission then revoked Gayle’s license in March 2020 and shortly after this, the other two locations closed.
Gayle admitted to the court that she distributed drugs including oxycodone, hydrocodone and methadone.
The couple admitted to conspiring to commit health care fraud for several years by billing insurers for office visits under Gayle’s name even when she did not see the patients, including times when she was not in the building and sometimes when she was not in town.
The couples state they knew what they were doing was fraud, but records show that they continued anyway.
In 2015, Blue Cross Blue Shield of Alabama (BCBS) says they audited the practice and uncovered that Gayle was absent and other staff members were seeing the patients, yet visits were still billed under Gayle’s name. This prompted BCBS to flag the business.
After this, Gayle reportedly promised to stop the fraudulent billing charges.
The DOJ says the business continued to fraudulently bill insurers over the next four years. In total, between 2015 and 2020, Medicare, Medicaid and Blue Cross paid more than $2.3 million for office visits billed under Gayle.
The couple also admitted to conspiring to commit wire fraud. After Gayle’s license was revoked, they applied for and attained more than $450,000 in COVID-19 disaster relief funds through the Paycheck Protection Program (PPP) and Economic Injury Disaster Loan program.
These specific program funds were designed to stabilize businesses that were struggling during the pandemic. In the funding applications, the couple certified that their practice needed money due to economic uncertainty or injury caused by the pandemic when the reality was that Gayle and Davis’ practice was closed and they used the funds on other things.
Gayle faces a maximum of 50 years in prison, while Davis faces a maximum of 30 years.
News article: Former North Alabama doctor and wife plead guilty to healthcare fraud charges (whnt.com)