Blue Cross plans in three states team up for fraud investigation

The Blue Cross Blue Shield plans in Michigan, Ohio and Pennsylvania joined forces to put a stop to health care fraud committed by Stacey Royal, M.D. and her boyfriend, Christopher Davis.

In 2009, the two were convicted of health care fraud charges in Wood County, Ohio. A key factor in the conviction was the fraud investigation conducted by Blue plan in Ohio.

While out on bond during the investigation in Ohio, Royal and Davis moved to Pennsylvania where Royal filed fraudulent drug claims totaling more than $500,000. The services were billed through Davis’ Blue Cross Blue Shield of Michigan contract. Because Davis was a Michigan Blue Cross member while residing in Pennsylvania, both the Michigan Blue Cross and Pennsylvania Highmark became involved in the investigation.

An investigator from the Corporate and Financial Investigation team at the Michigan Blue Cross 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 plead guilty to three counts of health care fraud, and the judge sentenced her to 11.5 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 Ohio Insurance Bureau recognized the success as the case of the year in 2009.

Subscribers, members, and even anonymous callers who suspect health care fraud should call our Anti-Fraud Hotline at 1-800-482-3787, or report fraud through our website.