Michigan, Ohio and Pennsylvania Blue plans work together in fraud investigation
The Blue Cross Blue Shield plans in Michigan, Ohio and Pennsylvania joined forces to put a stop to health care fraud being committed by Stacey Royal, M.D. and her boyfriend, Christopher Davis.
In 2009, the two were convicted in Wood County, Ohio on health care fraud charges. The fraud investigation conducted by the Blue plan in Ohio was a key factor in that conviction.
However, while out on bond during the investigation in Ohio, Royal and Davis moved to Pennsylvania where Royal filed fraudulent drug claims and was paid more than $500,000, billing the services through Davis’ Blue Cross Blue Shield of Michigan contract. Because Davis was a Michigan Blues member while residing in Pennsylvania, both the Michigan Blues and Pennsylvania Highmark became involved in the investigation.
An investigator from the Corporate and Financial Investigation team at the Michigan Blues traveled to the Pittsburgh area to work with Pennsylvania Highmark and help the prosecutor prepare for trial. The investigator then appeared in court on behalf of the prosecution. In February of 2014, Royal decided to plead guilty to three counts of health care fraud, and the judge sentenced her to 11 ½ to 23 months incarceration with restitution of $462,510.55.
This couple’s scheme to commit fraud in three states would have continued if not for the cooperation between Michigan, Ohio and Pennsylvania Blue Plans. The success of the 2009 case in Ohio was recognized as the Ohio Insurance Bureau case of the year.
If you suspect health care fraud, call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website at bcbsm.com.