HUNTSVILLE, Ala. (WHNT) – A north Alabama doctor and her wife have pleaded guilty to multiple counts of health care fraud, according to the U.S. Department of Justice.
In 2022, Francene Aretha Gayle and her wife, Schara Monique Davis, were charged with conspiracy to commit healthcare fraud and healthcare fraud.
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On June 10, Gayle pleaded guilty to five counts of illegal drug possession, one count of conspiracy to commit health care fraud and one count of conspiracy to commit wire fraud. Davis also pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit wire fraud.
The defendant’s plea agreement states that between 2014 and 2022, Gayle was the only physician in a multi-clinic practice in three north Alabama locations: Huntsville, Athens and Killen. Davis owned the company and served as business director.
In 2019, records show the Killen location was closed. The Alabama Medical Licensing Commission then revoked Gayle’s license in March 2020 and shortly after, the other two locations closed.
Gayle admitted in court that he distributed drugs such as oxycodone, hydrocodone and methadone.
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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 was not seeing patients, even when she was not in the building, and sometimes when I wasn’t in town.
The couples claim they knew what they were doing was fraud, but records show they continued anyway.
In 2015, Blue Cross Blue Shield of Alabama (BKeynoteUSA) says they audited the practice and found that Gayle was absent and other staff members were seeing patients, but the visits were still billed in Gayle’s name. This led BKeynoteUSA to report the company.
After this, Gayle allegedly promised to stop the fraudulent billing charges.
The Justice Department says the company continued to fraudulently bill insurers for 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.
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The couple also admitted to conspiring to commit wire fraud. After Gayle’s license was revoked, they applied for and obtained more than $450,000 in COVID-19 disaster relief funds through the Paycheck Protection Program (PPP) and the Damage Disaster Loan program. Economical.
These targeted program funds were designed to stabilize businesses that were struggling during the pandemic. In funding applications, the couple certified that their practice needed money due to economic uncertainty or damage 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.
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