Michigan Pharmacy Owners Convicted for $15M Health Care and Wire Fraud Scheme

TL/DR –

Pharmacist Raad Kouza and his brother Ramis Kouza, both from Michigan, were found guilty of conspiracy to commit health care fraud and wire fraud. They were convicted of billing Medicare, Medicaid, and Blue Cross Blue Shield of Michigan over $15 million for prescription medications that were not dispensed at their own pharmacies. Both face up to 20 years in prison, with Raad Kouza facing an additional 10 years for a separate health care fraud count; sentencing will be determined by a federal district court judge.

Fraudulent Pharmacy Owners Convicted by Federal Jury

A Michigan pharmacist, Raad Kouza, and his brother Ramis Kouza were found guilty today of conspiracy to commit health care fraud and wire fraud. They perpetrated this fraud through pharmacies they owned or operated in Wayne County and Oakland County, Michigan.

The pair submitted fraudulent claims to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan, billing for prescription medications that were never dispensed. The total loss caused by their actions exceeded $15 million.

Both brothers now face a maximum penalty of 20 years in prison for conspiracy. Raad Kouza could also serve an additional 10 years for a health care fraud conviction. Sentencing will be set at a future date, following consideration of the U.S. Sentencing Guidelines and other legal factors.

The case was announced by Principal Deputy Assistant Attorney General Nicole M. Argentieri, alongside Special Agents Cheyvoryea Gibson (FBI) and Mario Pinto (Department of Health and Human Services Office of Inspector General – HHS-OIG). The investigation was conducted by the FBI’s Detroit Field Office and HHS-OIG.

Department of Justice’s Efforts against Health Care Fraud

Prosecution is led by Trial Attorneys Claire Sobczak Pacelli, Jeffrey A. Crapko, and Andres Q. Almendarez, as part of the Fraud Section’s efforts to combat health care fraud. The Fraud Section is the spearhead of the Criminal Division’s Health Care Fraud Strike Force Program, which has charged over 5,400 defendants since March 2007 for collectively billing federal health care programs and private insurers more than $27 billion. The Centers for Medicare & Medicaid Services, alongside HHS-OIG, are also working to hold providers accountable for health care fraud schemes. For more information, visit the Department of Justice’s Healthcare Fraud Unit .

—
Read More Health & Wellness News ; US News