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Caught But Not Stopped

Caught But Not Stopped

Medicare enrollment form and glasses
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Aretha Gayle was a doctor who operated a multi-clinic practice in Alabama. Her wife, Monique Davis, conveniently owned the practice and served as business manager. Nothing says love like being in business together. Except if fraud is involved. And then there are going to be troubles in paradise. In 2014, Gayle and Davis began billing Medicare and Medicaid for patient visits that never occurred, including times when Gayle was not in the office or out of town. One year into their scheme, Gayle and Davis were caught by Blue Cross Blue Shield for fraudulent billing. But they didn’t stop.

In 2015, after Blue Cross Blue Shield of Alabama audited the practice and flagged the clinics for fraudulent billing, Gayle promised it would stop. Instead, Gayle and Davis continued fraudulently billing insurers for office visits for the next four years receiving more than $2.3 million from Medicare, Medicaid, and Blue Cross. Until they were once again caught. But not for fraudulent billing. This time they were stopped by the Drug Enforcement Administration for unlawful distribution of drugs, including oxycodone, hydrocodone, and methadone.

Yet these two still didn’t stop. Thanks to the DEA, Gayle lost her license, and the clinics were shut down in 2020. But months later, Gayle and Davis applied for and obtained more than $450,000 in COVID-19 disaster relief funds through the Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) program. Those funds were designed to stabilize businesses struggling because of the pandemic. Gayle and Davis they used the fraudulently obtained COVID-19 proceeds they received on everything but business expenses.

Great job by the FBI, DEA, and the HHS-OIG in this case.

Today’s Fraud of The Day is based on article “Former doctor, wife plead guilty in $2.3 million Huntsville painkiller scheme” published by AL.com on June 10, 2024.

A former doctor who practiced at three clinics in north Alabama pleaded guilty in federal court today, along with her wife, to drug distribution, wire fraud and healthcare conspiracy.

Francene Aretha Gayle, 50, and Schara Monique Davis, 48, both of Apopka, Fla., were before U.S. District Judge Liles Burke.Gayle pleaded guilty to five counts of unlawful drug distribution, one count of health care fraud conspiracy, and one count of wire fraud conspiracy.

Davis pleaded guilty to one count of health care fraud conspiracy and one count of wire fraud conspiracy. Gayle faces up to 50 years in prison, while Davis could receive up to 30 years in prison.

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