Ohio physician convicted of health care fraud and theft

She was trying to amass the riches of a queen, but Dr. Stacey Royal ended up being the court jester.

The Ohio Department of Insurance contacted Blue Cross Blue Shield of Michigan's Corporate Fraud and Investigations department about Dr. Stacey Royal, who ran the Royal Treatment Urgent Care in Perrysburg, Ohio. Dr. Royal was being investigated for billing for services not rendered on health care contracts of her family and friends without their knowledge. She had filed more than $900,000 in false claims to insurance companies, including approximately $135,000 to Blue Cross Blue Shield of Michigan.

The investigation initially identified false claims being submitted to Anthem Blue Cross Blue Shield of Ohio for our members. To prevent further losses, our investigators initiated a fraud alert to other Blue Cross plans, which prevented additional payments of more than $1 million in fraudulent claims submitted for our members.

Royal's trial began on Sept. 13, 2010. Investigators from Blue Cross Blue Shield of Michigan testified during the trial about the losses incurred as a result of Dr. Royal's scheme to defraud. Other testimony in the trial included a doctor who performed a surgical procedure that Dr. Royal observed for educational purposes. She then proceeded to submit a claim for performing the procedure, and her claim was for more than the amount the actual surgeon billed. On Sept. 16, 2010, Dr. Royal pleaded guilty to four counts each of insurance fraud and theft, two counts of telecommunications fraud and one count of engaging in a pattern of corrupt activity. She was sentenced to five years probation and full restitution to all victims.

Royal's boyfriend, Christopher Davis, also employed at the Royal Treatment Urgent Care, was also convicted of complicity to insurance fraud, complicity to theft and engaging in a pattern of corrupt activity. He was sentenced to 180 days in jail, one year probation and ordered to pay $100,497.59 in restitution to us for false claims on his personal insurance coverage.

Members who suspect health care fraud are urged to call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website.