A federal jury has convicted a pharmacy owner and his brother over a $15 million health care fraud scheme.
The court in Michigan found Raad Kouza and his brother Ramis Kouza carried out a massive fraud by billing Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescriptions they never dispensed.
The brothers were charged with conspiracy to commit health care fraud and wire fraud. Raad Kouza also faced a separate count of health care fraud.
They face as much as 20 years in prison for their conspiracy charge, with Raad Kouza facing an additional 10 year sentence for the health care fraud charge.
The sentencing hearings will be scheduled in the coming months, with the federal district court judge considering the U.S. Sentencing Guidelines and other statutory factors.
How the Scheme Operated
According to court documents and trial evidence, Raad and Ramis Kouza submitted false claims for medications at their Michigan-based pharmacies.
Although the medications were listed as dispensed, they were never actually given to patients. These fraudulent activities targeted both federal programs and private insurers:
- Medicare and Medicaid: Federal health programs providing insurance to the elderly, disabled, and low-income individuals.
- Blue Cross Blue Shield of Michigan: A private insurer widely used throughout the state.
This elaborate scheme allowed the Kouza brothers to illegally obtain millions from these health care programs, significantly impacting government and private health care funds.
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Legal and Investigative Response
The case was a collaborative effort between the US Department of Justice and federal investigative agencies, demonstrating the commitment to combating health care fraud on a national scale.
- Justice Department’s Criminal Division: Principal Deputy Assistant Attorney General Nicole M. Argentieri announced the conviction, underscoring the DOJ’s dedication to prosecuting fraudulent practices.
- Investigating Agencies:
- FBI Detroit Field Office: Led by Special Agent in Charge Cheyvoryea Gibson, played a critical role in gathering evidence and supporting the case.
- Department of Health and Human Services Office of Inspector General (HHS-OIG): Special Agent in Charge Mario Pinto provided additional investigative support and insights into the fraud’s impact on federal health care programs.
Legal Team
The prosecution was led by Trial Attorneys Claire Sobczak Pacelli, Jeffrey A. Crapko, and Andres Q. Almendarez from the DOJ’s Fraud Section, specializing in cases involving large-scale fraud impacting federal health care programs.
A Closer Look at the Health Care Fraud Strike Force
The Fraud Section, through its Health Care Fraud Strike Force Program, plays a pivotal role in identifying and prosecuting health care fraud nationwide. Launched in March 2007, this task force includes nine strike teams operating across 27 federal districts. So far, the initiative has:
- Charged over 5,400 defendants involved in fraud.
- Uncovered fraudulent claims totaling more than $27 billion.
These efforts aim to safeguard public health resources by holding those who commit fraud accountable, ensuring funds are properly allocated to those in need.
