CENTER STAR — The Alabama Board of Medical Examiners has revoked the license of a physician who operated a Lauderdale County clinic, and fined her $60,000 in connection with fraud and abuse of dispensing controlled substances, according to records.

Francene Aretha Gayle, who operated Advance Medical Clinic, 6492 U.S. 72, in the Center Star community, had the actions taken against her in March, according to the board.

The clinic is closed, and a Wednesday call to it revealed the number had been changed to an undisclosed number.

The order against Gayle, who also operated clinics in Athens and Huntsville, spells out the findings in the board's investigation.

It states she used her electronic medical records in a way that only allowed billing under her National Practitioner Identifier number, although she employed a number of certified registered nurse practitioners and billed every visit with any of the practitioners as one in which Gayle had personally seen the patient.

That resulted in a payment of an extra 15% by third-party payers. Gayle reportedly "ignored multiple warnings from Blue Cross and Medicaid" to change that billing method, and she did so "intentionally for the purpose of falsely inflating her billing to Blue Cross and Medicaid," according to the order.

It further claims she used a "code 25" billing code modifier on bills submitted to Blue Cross for the purpose of bypassing "edits" in order to try to avoid the bills being audited.

It states 92% of Gayle's bills to third-party payers were for visits gauged as level 4 or 5, which are levels are based on the amount of time the physician spends with a patient. Gayle did not spend those amounts of time with the patients, according to the order.

She also used an untrained medical assistant unsupervised in the Center Star clinic for three months, according to the order. It states Gayle would be there one day a week or less during that span, and she allowed the assistant and other medical assistants, whether trained or not, "to see patients, diagnose patients and treat patients, which included the administration of prescription medications," as well as X-ray patients.

The medications were administered by the staff "without knowledge of side effects and without any trained medical personnel or equipment on site to treat life-threatening complications," the order states.

Gayle also entered into an arrangement with a company in which she would refer her patients for urinary drug screenings, whether necessary or not, according to the order.

Gayle would pay the company $250 for a screening and bill Blue Cross for up to $1,200, the board states. Ultimately, that resulted in her being paid more than $2 million by third-party payers in 2014 and 2015, profiting approximately $1,738,606.

Gayle also is charged with entering into an agreement with another company in 2015 and 2016 that resulted in Medicaid paying more than $1 million.

Further, she is accused of giving "pre-signed blank prescription forms" to assistants in her clinic to prescribe controlled substances and other medication, according to the board.

She also wrote prescriptions ahead of appointments.

Another major element of the findings is Gayle prescribed narcotics in dangerous amounts and combinations.

In one example it states "Dr. Gayle would prescribe opioid pain medications in combination with benzodiazepines and Soma (carisoprodol), a combination highly sought after as a street drug and known as 'the holy trinity.'"

Blue Cross sent letters to Gayle warning of the risks, which include respiratory depression and death, but she ignored them, the order states.

In addition, she "routinely prescribed opioid pain medications to patients in daily morphine milligram equivalents (MMEs) which far exceeded the federally recommended threshold" of 90, the order states. It lists examples of 135 to 360 MMEs.

She ranked 11th among 19,650 Alabama prescribers in controlled substance prescriptions in 2015, the order states. or 256-740-5739. Twitter @TD_BDelinski

(1) comment

Roll Tide

Bcbs of al loves to stick the bill to a premium payimg patient if the service provided is not provided by the patients predesignated primary care select physician or a provider number that has been consulted by that particular physician. $600 because i didnt have a consult entered for my physicians crnp. If there had been one they only would have paid my doctor $106 lol the reimbursement rates and tax id/ provider id/facility id’s are the real holy trinity bcbs is worried about. As for opiates legally prescribed to drug screened patients are better than people committing suicide or turning to the street for fentanyl or worse. Sad the doctor has to lie for 15% more bc bcbs only pays 15% of the submitted bill. Health care billing is a joke.

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