Defendants’ Organization Billed Nearly $2 Billion in Fraudulent Prescriptions from Over 75 Pharmacies Nationwide Including in Brooklyn, Staten Island, Long Island and New Jersey
Earlier today, at the federal courthouse in Brooklyn, Anthony Santamaria was sentenced by U.S. District Judge William F. Kuntz II to 10 years in prison for his participation in an approximately $2 billion international health care fraud conspiracy. Santamaria is the third member of a Moscow-based criminal organization sentenced this month in connection with the scheme. Co-defendants Hershel Tsikman and Hafizullah Ebady were sentenced earlier this month to 120 months’ and 97 months’ imprisonment, respectively. In addition to the terms of imprisonment, Judge Kuntz ordered Santamaria to forfeit $3.2 million and Ebady to forfeit more than $1.8 million. Additionally, all three defendants were ordered to pay restitution to their victims in an amount to be determined at a later date. A fourth defendant, Dela Saidazim, was sentenced to time served in December 2022. Three additional co-defendants, David Bishoff, Brycen Millett and Joshua Alegria, are awaiting sentencing. An eighth co-defendant and the leader of the criminal organization, Brian Sutton, a U.S. citizen who is believed to be residing abroad, remains at large.
“This Moscow-based criminal organization provided anything but health care,” said Assistant Attorney General for the National Fraud Enforcement Division Colin M. McDonald. “Through aliases, encrypted communications, shell companies, and straw owners, these defendants siphoned nearly $2 billion from private insurers that provide services to American patients. They executed a brazen international fraud scheme involving sham call centers, ghost telemedicine visits, and remotely controlled pharmacies—with many patients never receiving the medication. The Justice Department will continue to aggressively identify, target, and prosecute those who defraud America’s health care system.”
“For over five years, the defendants built a sophisticated, international criminal organization that employed scores of call center employees and remote-billers to steal hundreds of millions of dollars from American businesses and launder the stolen monies overseas,” said U.S. Attorney Joseph Nocella Jr. for the Eastern District of New York. “Despite the defendants’ aliases, encrypted messaging platforms, shell companies and straw owners, even operating from overseas, they are now being held accountable. Our Office and our law enforcement partners will continue to dismantle complex health care fraud networks and hold every responsible actor accountable.”
“The takedown of this international criminal organization sends a clear message that those who exploit our American healthcare system for profit – no matter where they operate – will be identified, investigated, and prosecuted,” said FBI Assistant Director in Charge James Barnacle Jr.
According to court filings and proceedings, between 2017 and 2022, the defendants engaged in an international scheme to fraudulently bill private health care benefit programs (the Private Insurers). They executed their scheme by having call centers they controlled, initially in Utah and later in Russia, contact beneficiaries enrolled with the Private Insurers and offer medications at no cost to the beneficiaries and without any medical exams to determine if the medications were necessary. Regardless of whether the beneficiaries agreed to receive these medications, the defendants generated fraudulent prescriptions for the medications for these beneficiaries. The defendants also recruited doctors purportedly to review prescriptions by nurse practitioners and physician’s assistants after telemedicine visits. Contrary to what the recruited doctors were told, in most cases there were no telemedicine visits between the beneficiaries and any medical professionals. The defendants generated fraudulent prescriptions under the physicians’ names and National Provider Identifier numbers. Despite the prescriptions, many beneficiaries never received the medications.
The defendants also acquired pharmacies across the United States with pre-existing relationships with the Private Insurers and trained and managed teams of Moscow-based “billers” to input data and remotely submit electronic reimbursement requests for the fraudulent prescriptions through those pharmacies. The defendants submitted over $1.97 billion in fraudulent prescriptions according to third-party billing records. Private Insurers paid over $758 million as a result of those fraudulent submissions.
To conceal their involvement in the scheme, the defendants operated under multiple aliases, funneled hundreds of millions of dollars through pass-through shell companies and straw owners, used end-to-end encrypted communications and moved operations overseas. Specifically, the defendants purchased and operated dozens of existing brick-and-mortar pharmacies through straw owners, including in Brooklyn, Staten Island, Manhattan, Long Island, New Jersey, Pennsylvania, Texas, Michigan and Alabama. The defendants also laundered millions of dollars in fraudulent proceeds from overseas through pass-through shell companies that they used to purchase the scheme pharmacies and conceal the defendants’ involvement.
Under Sutton’s direction, the defendants played various roles in the scheme, including as follows:
- Alegria oversaw development of custom software and forwarded fraudulent prescriptions to licensed physicians for approval;
- Bishoff coordinated logistics for the operations of multiple scheme pharmacies;
- Ebady coordinated the purchase of and was the “boots-on-the-ground manager” for at least 30 scheme pharmacies;
- Millett oversaw call centers in Utah, Russia and elsewhere overseas;
- Saidazim recruited licensed physicians and acted as Sutton’s personal assistant;
- Santamaria trained and managed teams of billers to input data and remotely submit fraudulent requests for reimbursement to insurers; and
- Tsikman coordinated the laundering of fraud proceeds through straw owners and shell entities for at least 30 scheme pharmacies, and personally wired millions of dollars internationally.
The government’s case is being handled by the Office’s Business and Securities Fraud Section. Assistant U.S. Attorneys John Vagelatos, Jessica K. Weigel, Jonathan P. Lax and Tara B. McGrath for the Eastern District of New York are in charge of the prosecution, with the assistance of Paralegal Specialist Melina Piatti-Chayan. Assistant U.S. Attorney Claire S. Kedeshian for the Eastern District of New York is handling forfeiture matters.
An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division (“Fraud Division”). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department’s work to combat fraud supports President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.
