Pharmacist and Brother Convicted for Orchestrating $15 Million Healthcare Fraud Scheme.
A federal jury has convicted a Michigan-based pharmacist and his brother for orchestrating an elaborate healthcare fraud scheme that defrauded Medicare, Medicaid, and private insurance companies out of $15 million.
Raad Kouza, a licensed pharmacist operating in Wayne County, Michigan, and his brother, Ramis Kouza, from Oakland County, Michigan, were found guilty of conspiracy to commit healthcare fraud and wire fraud.
The fraudulent actions took place between 2015 and 2020, during which the defendants submitted false claims to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. These claims were for prescription medications that were never actually dispensed at their pharmacies.
Court documents and trial evidence revealed that the Kouzas falsified prescriptions and submitted them to these insurance programs for reimbursement, despite the medications not being provided to patients. The fraudulent claims were submitted on a massive scale, resulting in financial losses exceeding $15 million to these vital healthcare programs.
Both Raad and Ramis Kouza were convicted of conspiracy to commit healthcare fraud and wire fraud. In addition to the conspiracy charge, Raad Kouza was also convicted on one count of healthcare fraud.
The charges carry serious penalties. Each defendant faces a maximum sentence of 20 years in prison for the conspiracy charge, with Raad Kouza potentially facing an additional 10 years for the healthcare fraud conviction.
The final sentencing will be determined by a federal district court judge, who will consider the U.S. Sentencing Guidelines and other relevant factors before issuing the sentences.
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