Indictment — United States v. Francene Aretha Gayle and Schara Monique Davis, Northern District of Alabama
Summary
A grand jury indictment against Francene Aretha Gayle and Schara Monique Davis in the United States District Court for the Northern District of Alabama, Northeastern Division, Case 5:22-cr-00113-LCB-HNJ, filed April 27, 2022 as Document 1. Count One charges conspiracy to unlawfully distribute and dispense controlled substances under 21 U.S.C. § 846, and Counts Two Through Six charge Gayle with unlawful dispensing of Schedule II substances such as oxycodone under 21 U.S.C. § 841(a)(1) and (b)(1)(C). Count Seven charges conspiracy to commit health care fraud under 18 U.S.C. § 1349 against Medicare, Medicaid and Blue Cross. The indictment alleges that Gayle, a physician, and Davis, business manager of clinics in Huntsville, Athens and Killen, billed for services not provided and prescriptions issued without a legitimate medical purpose.
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“Indictment — United States v. Francene Aretha Gayle and Schara Monique Davis, Northern District of Alabama.”
Original at ecf.alnd.uscourts.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/indictment-usa-v-gayle-et-al-dkt-1-dea2980708/
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Case 5:22-cr-00113-LCB-HNJ Document 1 Filed 04/27/22 Page 1 of 18 FILED
2022 Apr-28 PM 02:22
U.S. DISTRICT COURT
N.D. OF ALABAMA
PFE / JBW: May 2022
GJ # 33
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ALABAMA
NORTHEASTERN DIVISION
UNITED STATES OF AMERICA )
)
v. )
)
FRANCENE ARETHA GAYLE and )
SCHARA MONIQUE DAVIS )
INDICTMENT
The Grand Jury charges:
Introduction
At all times relevant to this Indictment:
The Defendants
1. FRANCENE ARETHA GAYLE was licensed by the state of
Alabama to practice medicine. She maintained a Drug Enforcement Administration
(DEA) registration number that allowed her to write prescriptions for controlled
substances. She maintained a Medicare Provider Identification Number (PIN) and
National Provider Identifier (NPI) number under which her clinics submitted claims
to health care benefit programs for reimbursement for services purportedly provided.
2. GAYLE served as the physician at three clinics located in the Northern
District of Alabama: Mission Square Medical Clinic in Huntsville; Athens Medical
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Clinic in Athens; and Advanced Medical Care in Killen. Complete Medical Health
was the legal or tax name for the three clinics. The Killen clinic ceased operations
by 2019; the other two clinics ceased operations in 2020.
3. SCHARA MONIQUE DAVIS operated the clinics with GAYLE.
DAVIS served as the business manager for the clinics and participated in billing
health care benefit programs for services purportedly rendered by GAYLE.
4. GAYLE, DAVIS, and others known and unknown to the grand jury
conspired to unlawfully distribute and dispense controlled substances through
prescriptions that were issued without a legitimate medical purpose outside the usual
course of professional practice.
5. GAYLE, DAVIS, and others known and unknown to the grand jury
conspired to engage in, and did engage in, a scheme to defraud health care benefit
programs for: (1) services that were not provided, including medical office visits
billed as if GAYLE was the rendering provider when she was not; and (2) medically
unnecessary items and services, including prescriptions for controlled substances
issued without a legitimate medical purpose and outside the course of usual
professional practice that would be billed to health care benefit programs.
Health Care Benefit Programs
6. The Medicare Program (Medicare) is a federal health care program that
provides benefits to persons over the age of sixty-five and to qualifying persons with
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disabilities. Medicare is administered by the Centers for Medicare and Medicaid
Services (CMS), a federal agency under the United States Department of Health and
Human Services.
7. The Alabama Medicaid Program (Medicaid) is a joint federal and state
health insurance program that provides free and below-cost insurance to low-income
individuals and families. It is administered by Alabama in coordination with CMS.
8. Blue Cross Blue Shield of Alabama (Blue Cross) is an entity that
provides private health insurance to individuals.
9. Medicare, Medicaid, and Blue Cross are “health care benefit programs”
as defined in Title 18, United States Code, Section 24(b). These plans and others
provide health benefits including for office visits and prescription drugs. Individuals
who receive benefits under these programs are typically referred to as
“beneficiaries.” Medicare and Medicaid are “federal health care programs” as
defined in Title 42, United States Code, Section 1320a-7b(f).
Billing for Medical Services
10. Medicare, Medicaid, and Blue Cross make insurance payments directly
to a provider of medical services or goods, rather than to a beneficiary. Such
payments occur after the provider submits a claim for payment to the health care
benefit program. When a health care provider submits a claim for payment, the
provider certifies that services or goods being provided to a patient are provided in
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accordance with the requirements of the health care benefit program.
11. To be eligible to receive payments for the provision of services to
beneficiaries of Medicare, Medicaid, or Blue Cross, a provider must enroll with that
program. To enroll with a health care benefit program, a provider must agree to
comply with all relevant regulations of the health care benefit program or any third-
party intermediaries through which claim payments could be received, adjudicated,
and paid. These regulations require that providers submit claims for services only
where those services are reasonable and medically necessary.
12. Health care benefit programs provide guidance to participating health
care providers regarding proper billing procedures, rules, and regulations for their
programs.
13. To obtain payment from a health care benefit program for services
provided, the provider or its designee must submit a claim. The claim must include,
among other things: (1) the provider’s unique provider number; (2) the patient’s
name; (3) the patient’s diagnosis prescribed by a standardized code; (4) a description
of medical services rendered to the patient using standardized codes; (5) the date and
location the medical services were provided; and (6) the amount claimed for the
payment.
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14. Medicare, Medicaid, and Blue Cross will pay a health care provider
only for medical services or goods that are medically necessary for the treatment of
the patient being provided the services or goods.
15. Health care benefit programs rely on health care providers to submit
true and accurate claims for services provided.
Office Visit Billing
16. Medicare, Medicaid, and Blue Cross will pay for certain medically
reasonable and necessary services, such as office visits, provided to their
beneficiaries.
17. Medicare, Medicaid, and Blue Cross rely on standardized code sets to
pay health care claims including for office visits. One such code set, the Current
Procedural Terminology (CPT), consists of five-digit codes listing certain
procedures and services performed or ordered by health care providers. The
procedures and services represented by CPT codes are health care benefits, items,
and services within the meaning of Title 18, United States Code, Section 24(b).
18. When claims are submitted to health care benefit programs, health care
providers or their designees are expected to identify the proper CPT code or other
identifier corresponding to the medical service provided, as well as any appropriate
modifiers to designate personnel who performed the visit. Services provided by
nurses or other medical staff may be reimbursed by health care benefit programs at
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a lower rate than services provided by physicians.
19. Medicare, Medicaid, and Blue Cross require health care providers
enrolled with their programs to maintain complete and accurate patient medical
records reflecting the medical assessment and diagnoses of their patients, as well as
records documenting actual treatment of the patients to whom services were
provided and for whom claims for payment were submitted by the physician or other
health care provider. Health care benefit programs require complete and accurate
patient medical records so that it is possible to later verify that the services were
provided as described on the claim form. These records are required to be sufficient
to permit the programs to review the appropriateness of payments made to the health
care provider.
Controlled Substances
20. The Controlled Substances Act (CSA) governs the manufacture,
distribution, and dispensing of controlled substances in the United States. With
limited exceptions for medical professionals, the CSA makes it unlawful for any
person to knowingly or intentionally manufacture, distribute, or dispense a
controlled substance or conspire to do so.
21. The CSA and its implementing regulations set forth which drugs and
other substances are defined by law as “controlled substances,” and assign those
controlled substances to one of five schedules (Schedule I, II, III, IV, or V)
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depending on their potential for abuse, likelihood of physical or psychological
dependency, accepted medical use, and accepted safety for use under medical
supervision.
22. The assignment of a controlled substance to Schedule II means that the
drug has a high potential for abuse, is highly addictive, and has a currently accepted
medical use in treatment in the United States or a currently accepted medical use
with severe restrictions. Abuse of a Schedule II controlled substance could lead to
severe psychological or physical dependence. Pursuant to the CSA and its
implementing regulations, oxycodone is a Schedule II controlled substance,
methadone is a Schedule II controlled substance, and hydrocodone has been a
Schedule II controlled substance since October 2014 (before which time it had been
a Schedule III controlled substance). Oxycodone, methadone, and hydrocodone are
opioid pain medications with a high potential for abuse and associated risk of
overdose.
23. Benzodiazepines such as alprazolam and clonazepam are Schedule IV
controlled substances and are commonly prescribed to treat anxiety. It is well known
that the combination of high-dose opioids and benzodiazepines may present a
significant risk of patient intoxication and overdose. To prescribe a combination of
high-dose opioids and benzodiazepines for a legitimate medical purpose, a physician
must determine, at a minimum, that the benefits of the drugs outweigh the risks to
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the patient’s life.
24. Health care providers are authorized under the CSA to prescribe, or
otherwise distribute, controlled substances, if they are registered with the Attorney
General of the United States. See Title 21, United States Code, Section 822(b);
Chapter 21, Code of Federal Regulations, Section 1306.03. Upon application, the
DEA assigns a unique registration number to each qualifying health care provider
including physicians and nurse practitioners.
25. Chapter 21 of the Code of Federal Regulations, Section 1306.04,
governs the issuance of prescriptions and provides, among other things, that a
prescription for a controlled substance “must be issued for a legitimate medical
purpose by an individual practitioner acting in the usual course of [her] professional
practice.”
26. Chapter 21 of the Code of Federal Regulations, Section 1306.04, also
directs that “[a]n order purporting to be a prescription issued not in the usual course
of professional treatment . . . is not a prescription within the meaning and intent of
[the CSA] and the person knowingly filling such a purported prescription, as well as
the person issuing it, shall be subject to the penalties provided for violations of the
provisions of law relating to controlled substances.”
27. Health care benefit programs will not pay for controlled substances
dispensed or distributed by way of an unlawful prescription.
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28. Under federal law, “all prescriptions for controlled substances shall be
dated as of, and signed on, the day when issued and shall bear the full name and
address of the patient, the drug name, strength, dosage form, quantity prescribed,
directions for use, and the name, address and registration number of the
practitioner.” Chapter 21, Code of Federal Regulations, Section 1306.05(a).
29. The Alabama Board of Medical Examiners has established similar
requirements for controlled substance prescriptions. Those requirements include the
provision that “[i]t is improper, under any circumstances, for a physician to pre-sign
blank prescription pads or forms and make them available to employees or support
personnel.” Alabama Administrative Code, Chapter 540-X-4-.06(8).
COUNT ONE
Conspiracy to Unlawfully Distribute and Dispense Controlled Substances
[21 U.S.C. § 846]
30. Paragraphs 1 through 29 of this Indictment are realleged and
incorporated as though fully set forth herein.
31. From at least in or about 2015 through in or about March 2020, more
exact dates being unknown to the grand jury, in Madison, Limestone, and
Lauderdale Counties, within the Northern District of Alabama and elsewhere, the
defendants,
FRANCENE ARETHA GAYLE and
SCHARA MONIQUE DAVIS,
knowingly and intentionally conspired, combined, confederated, and agreed with
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each other, and with others known and unknown to the grand jury, to violate Title
21, United States Code, Section 841(a)(1), that is, to knowingly, intentionally, and
unlawfully distribute and dispense, and cause to be distributed and dispensed,
mixtures and substances containing a detectable amount of Schedule II controlled
substances, through prescriptions that were not issued for a legitimate medical
purpose by a practitioner acting in the usual course of professional practice.
All in violation of Title 21, United States Code, Section 846.
COUNTS TWO THROUGH SIX
Unlawful Dispensing of a Controlled Substance
[21 U.S.C. § 841(a)(1) and (b)(1)(C)]
32. Paragraphs 1 through 31 of this Indictment are realleged and
incorporated as though fully set forth herein.
33. On or about the dates listed below, within Madison, Limestone, and
Lauderdale Counties, within the Northern District of Alabama and elsewhere,
defendant
FRANCENE ARETHA GAYLE
did knowingly, intentionally, and unlawfully distribute and dispense, and cause to
be distributed and dispensed, mixtures and substances containing a detectable
amount of Schedule II controlled substances, through prescriptions that were not
issued for a legitimate medical purpose by a practitioner acting in the usual course
of professional practice.
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Count Date on Prescription Patient Substance
2 July 14, 2017 D.C. Oxycodone 10 mg
3 April 5, 2018 M.D. Oxycodone HCL 15 mg
4 April 5, 2018 M.D. Hydrocodone 10 mg
5 May 11, 2017 T.D. Methadone HCL 10 mg
6 November 30, 2018 T.J. Oxycodone HCL 30 mg
All in violation of Title 21, United States Code, Section 841(a)(1) and
(b)(1)(C).
COUNT SEVEN
Conspiracy to Commit Health Care Fraud
[18 U.S.C. § 1349]
34. Paragraphs 1 through 33 of this Indictment are realleged and
incorporated as though fully set forth herein.
35. From at least in or about 2015 through in or about March 2020, more
exact dates being unknown to the grand jury, in Madison, Limestone, and
Lauderdale Counties, within the Northern District of Alabama and elsewhere, the
defendants,
FRANCENE ARETHA GAYLE and
SCHARA MONIQUE DAVIS,
knowingly and intentionally conspired, combined, confederated, and agreed with
each other, and with others known and unknown to the grand jury, to execute a
scheme and artifice to defraud health care benefit programs affecting commerce, as
defined in Title 18, United States Code, Section 24(b), that is, Medicare, Medicaid,
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Blue Cross, and others, and to obtain, by means of materially false and fraudulent
pretenses, representations and promises, money and property owned by, and under
the custody and control of, said health care benefit programs, in connection with the
delivery of and payment for health care benefits, items and services, in violation of
Title 18, United States Code, Section 1347.
Purpose of the Conspiracy
36. It was the purpose of the conspiracy for GAYLE, DAVIS, and their
co-conspirators to unlawfully enrich themselves by submitting and causing to be
submitted and aiding and abetting in the submission of false and fraudulent claims
for medical services and prescription drugs that were not medically necessary, not
properly provided, or both.
Manner and Means
37. The manner and means by which the defendants and their co-
conspirators sought to accomplish the object and purpose of the conspiracy included,
among others, the following:
38. GAYLE was enrolled as a Preferred Provider of Blue Cross and was
enrolled in Medicare and Medicaid, among other health care benefit programs. In
doing so, GAYLE agreed only to bill for medically reasonable and necessary
services that were actually rendered.
39. In documents submitted to health care benefit programs on behalf of
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the clinics, DAVIS made similar certifications.
40. Despite these promises, GAYLE and DAVIS caused numerous false
claims for services to be billed to Medicare, Medicaid, Blue Cross, and other
insurers.
41. GAYLE and DAVIS falsely billed or caused to be billed health care
benefit programs for items and services as though GAYLE herself had provided
them. Between at least 2015 and 2020, GAYLE and DAVIS submitted or caused
to be submitted claims to healthcare benefit programs for millions of dollars in office
visits where GAYLE purportedly had seen the patients, when in fact she had not.
42. In fact, GAYLE frequently did not see patients for whom doctor office
visits were billed under her name and provider number, and untrained office staff or
other medical personnel saw those patients instead. GAYLE was frequently absent
from her clinics altogether.
43. GAYLE and DAVIS continued to bill and cause to be billed health care
benefit programs for office visits under GAYLE’s name and provider number that
GAYLE did not provide, even after receiving warnings from health care benefit
programs and others that such billing practices were not allowed.
44. GAYLE also caused her practice to maintain a large number of patients
through the prescription of medically unnecessary controlled substances. GAYLE
routinely issued and caused to be issued to such patients prescriptions for controlled
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substances without a legitimate medical purpose and outside the usual course of
professional practice, knowing that they would be filled by pharmacies and
submitted to health care benefit programs for reimbursement.
45. As a result of the conspiracy to defraud health care benefit programs,
GAYLE and DAVIS submitted and caused to be submitted and aided and abetted
in the submission of millions of dollars in false and fraudulent claims to Medicare,
Medicaid, Blue Cross, and other insurers.
All in violation of Title 18, United States Code, Section 1349.
COUNTS EIGHT THROUGH FIFTEEN
Health Care Fraud
[18 U.S.C. §§ 1347 & 2]
46. Paragraphs 1 through 45 of this Indictment are realleged and
incorporated as though fully set forth herein.
47. On or about the dates listed below, within Madison, Limestone, and
Lauderdale Counties, within the Northern District of Alabama and elsewhere, the
defendants,
FRANCENE ARETHA GAYLE and
SCHARA MONIQUE DAVIS,
did knowingly and willfully execute, and attempt to execute, a scheme and artifice
to defraud health care benefit programs affecting commerce, as defined by Title 18,
United States Code, Section 24(b), and to obtain, by means of materially false and
fraudulent pretenses, representations, and promises, money and property owned by,
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and under the custody and control of, said health care benefit programs, in
connection with the delivery of and payment for health care benefits, items and
services.
Purpose of the Scheme and Artifice
48. Paragraph 36 of this Indictment is realleged and incorporated as though
fully set forth herein as a description of the purpose of the scheme and artifice.
Manner and Means of the Scheme and Artifice
49. Paragraphs 37 through 45 of this Indictment are realleged and
incorporated as though fully set forth herein as a description of the manner and
means of the scheme and artifice.
Acts in Execution of the Scheme and Artifice
50. On or about the dates listed below, within Madison, Limestone, and
Lauderdale Counties, within the Northern District of Alabama and elsewhere,
defendants GAYLE and DAVIS submitted, caused to be submitted, and aided and
abetted in the submission of the following claims to health care benefit programs:
Ct. Beneficiary Date of Date Claim Service Billed Health Care
Service Submitted Program
8 H.R. 5/18/2017 12/12/2017 Office visit 99214 Medicaid
9 Ta.D. 5/18/2017 12/13/2017 Office visit 99214 Blue Cross
10 Ti.D. 5/14/2018 6/26/2018 Office visit 99214 Blue Cross
11 M.G. 10/24/2018 10/26/2018 Office visit 99214 Blue Cross
12 J.B. 10/24/2018 10/26/2018 Office visit 99214 Medicare
13 J.B. 10/24/2018 11/12/2018 Office visit 99214 Blue Cross
FEP
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Ct. Beneficiary Date of Date Claim Service Billed Health Care
Service Submitted Program
14 C.E. 10/25/2018 7/9/2019 Office visit 99214 Medicaid
15 C.E. 9/11/2019 10/1/2019 Office visit 99214 Medicaid
All in violation of Title 18, United States Code, Sections 1347 and 2.
FIRST NOTICE OF FORFEITURE
[21 U.S.C. § 853]
1. The allegations in Counts 1 through 6 of this Indictment are hereby re-
alleged and incorporated by reference for the purpose of alleging forfeiture pursuant
to Title 21, United States Code, Section 853.
2. Upon conviction of the offenses set forth in Counts 1 through 6 of this
Indictment, GAYLE and DAVIS shall forfeit to the United States of America,
pursuant to Title 21, United States Code, Section 853, any property, real or personal,
constituting, or derived from, any proceeds obtained, directly or indirectly, as the
result of such offenses and any property used, or intended to be used, in any manner
or part, to commit, or to facilitate the commission of, the offenses.
3. If any of the property described above, as a result of any act or omission
of the defendants:
a. cannot be located upon the exercise of due diligence;
b. has been transferred or sold to, or deposited with, a third party;
c. has been placed beyond the jurisdiction of the court;
d. has been substantially diminished in value; or
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e. has been commingled with other property which cannot be
divided without difficulty,
the United States of America shall be entitled to forfeiture of substitute property
pursuant to Title 21, United States Code, Section 853(p).
All pursuant to 21 U.S.C. § 853.
SECOND NOTICE OF FORFEITURE
[18 U.S.C. § 982(a)(7)]
1. The allegations in Counts 7 through 15 of this Indictment are hereby
re-alleged and incorporated by reference for the purpose of alleging forfeiture
pursuant to Title 18, United States Code, Section 982(a)(7).
2. Upon conviction of the offenses set forth in Counts 7 through 15 of this
Indictment, GAYLE and DAVIS shall forfeit to the United States of America,
pursuant to Title 18, United States Code, Section 982(a)(7), any property, real or
personal, that constitutes or is derived, directly or indirectly, from gross proceeds
traceable to the commission of the offenses.
3. If any of the property described above, as a result of any act or omission
of the defendants:
a. cannot be located upon the exercise of due diligence;
b. has been transferred or sold to, or deposited with, a third party;
c. has been placed beyond the jurisdiction of the court;
d. has been substantially diminished in value; or
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e. has been commingled with other property which cannot be
divided without difficulty,
the United States of America shall be entitled to forfeiture of substitute property
pursuant to Title 21, United States Code, Section 853(p), as incorporated by Title
18, United States Code, Section 982(b)(1) and Title 28, United States Code, Section
2461(c).
All pursuant to 18 U.S.C. § 982(a)(7) and 28 U.S.C. § 2461(c).
A TRUE BILL
/s/Electronic Signature
FOREPERSON OF THE GRAND JURY
PRIM F. ESCALONA
United States Attorney
/s/Electronic Signature
__________________________
JOHN B. WARD
Assistant United States Attorney
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