Pharmacist and Brother Convicted of $15M Medicare, Medicaid, and Private Insurer Fraud Scheme

 

A federal jury convicted a pharmacy owner and his brother for conspiracy to commit health care fraud and wire fraud.

According to court documents and evidence presented at trial, Raad Kouza, a pharmacist in Wayne County, Michigan, and his brother, Ramis Kouza, of Oakland County, Michigan, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. The defendants collectively caused over $15 million of loss to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.

Raad Kouza and Ramis Kouza were convicted of conspiracy to commit health care fraud and wire fraud. Raad Kouza was also convicted of one count of health care fraud. Both defendants face a maximum penalty of 20 years in prison on the conspiracy count, and Raad Kouza faces a maximum penalty of 10 years in prison on the health care fraud count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Sentencing hearings will be set at a later date.

Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division; Special Agent in Charge Cheyvoryea Gibson of the FBI Detroit Field Office; and Special Agent in Charge Mario Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI Detroit Field Office and HHS-OIG investigated the case.

Trial Attorneys Claire Sobczak Pacelli, Jeffrey A. Crapko, and Andres Q. Almendarez of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.