CENTER STAR- A physician who had a clinic in Center Star has had her license revoked and owes a $60,000 fine after an Alabama Board of Medical Examiners say she committed fraud and overprescribed controlled substances.
The board’s order against Dr. Francene Aretha Gayle was issued in March and involves actions she took at the now-closed Advance Medical Clinic, 6492 U.S. 72, in the Center Star community, as well as clinics in Huntsville and Athens.
The order provides descriptions of offenses, including a scheme the board says allowed Gayle to profit from Blue Cross and Medicaid to the tune of more than $2.7 million. In other cases, she gave too many amounts of opioids and prescribed additional medications that are dangerous when mixed with opioids, creating a substance that is known as “the Holy Trinity.”
Among incidents described in the order:
–Through electronic medical records, she used a system that automatically billed under her National Practitioner Identifier number, even if someone else saw a patient at the clinic. That caused an extra 15 percent in payments by third-party payors. Blue Cross and Medicaid issued “multiple warnings” to Gayle about doing that but she continued.
–She used a billing code modifier when submitting bills to Blue Cross in order to bypass “edits” that could cause the bills to be audited.
–In 92 percent of her bills to third-party payors, Gayle listed her patient appointments as Level 4 or 5. The levels indicated the amount of time a physician spends with a patient. She did not spend those amounts of time.
–She allowed an untrained medical assistant to work unsupervised in the Center Star clinic for three months. The assistant diagnosed and treated patients, gave X-rays and administered prescription medications.
–She and two separate companies worked out an arrangement in which she would pay the companies for screenings and bill either Blue Cross or Medicaid higher amounts. Gayle profited approximately $1,738,606 off the providers through one company and more than $1 million through another.
–Gayle gave her assistants “pre-signed blank prescription forms” and also wrote prescriptions ahead of appointments. These incidents included controlled substances.
–She prescribed opioids in amounts that exceed the “federally recommended threshold” and prescribed dangerous combinations. Those include a combination of opioids with benzodiazepines and carisoprodol, which is known as “the Holy Trinity” on the streets.
–In 2015, Gayle was ranked 11th among 19,650 Alabama prescribers in controlled substance prescriptions.
