Doctor with Glen Osborne Practice Charged with Insurance Fraud

A family physician from Ohio is facing felony charges accused of billing more than $2 million in false insurance claims through her Glen Osborne medical practice.

The Pennsylvania Attorney General’s office has filed charges against Dr. Stacey Y. Royal, 48, Marysville, Ohio, including six felony counts of theft by deception and three felony counts of insurance fraud.

According to a criminal complaint, Royal established the Royal Treatment Urgent Care, Inc. at 1106 Ohio River Boulevard, Suite 602, in June 2009 while she was also under criminal investigation in Ohio for submitting false claims. 

An investigator with the insurance fraud section of the AG's office reports that Royal duplicated and grossly inflated claims billed to Highmark and Michigan Blue Cross. 

Between July 2009 and March 2010, she billed more than $1.65 million in false claims for her husband, Christopher Davis, and received $458,300 in payments, the complaint states.  Highmark policy prohibits reimbursements for professional services to immediate relatives or household members. 

The complaint said Royal also billed Highmark $54,477 in claims from July 2009 to September 2009 for services she provided to a high school friend. Royal received $4,208 in payments, although the complaint says she never rendered many of the services. 

A Highmark official, in reviewing Royal's claims, discovered 12 line items totaling more than $629,000 in dispensed medications that should have cost less than $1,000 for a one-month supply of the drugs. 

The drugs included antibiotics, codeine syrup and allergy medications.

The complaint states that Royal was able to get more money back and avoid regular billing standards by using a code intended only to be used when medication is administered during a procedure. 

A criminal investigation into her practices began in April 2010 after the Ohio Department of Insurance contacted the insurance fraud division of the AG’s office regarding similar charges in Ohio.  

Royal was indicted in Ohio on Nov. 4, 2009 for felony theft, telemarketing fraud, insurance fraud and engaging in the pattern of corrupt activity.  She pleaded guilty, was sentenced to five years probation and ordered to pay $234,144 in restitution and a $10,000 fine.

Davis, was the office manager at the medical facility, and was also indicted on aiding and abetting, and engaging in the pattern of corrupt activity. Davis was found guilty on all charges, sentenced to six months in jail and ordered to pay $133,000 in restitution.

The Ohio indictment showed between 2004 and 2009, Royal billed for 180 treatments and office visits for Davis, and also billed an insurer for performing a heart surgery she did not do, the complaint said. 

Royal remains in Allegheny County Jail unable to post $25,000 bond. A preliminary hearing is scheduled for July 30 at Leetsdale District Court.  

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