Pharmacy owner Raad Kouza and brother Ramis Kouza defrauded Medicare, Medicaid, and Blue Cross Blue Shield of Michigan of over $15 million.

Pharmacist and Brother Found Guilty of Multi-Million Dollar Fraud Scheme

In a major health care fraud case, a federal jury has convicted Raad Kouza, a pharmacist from Wayne County, and his brother, Ramis Kouza, of Oakland County, for orchestrating a $15 million scheme that targeted Medicare, Medicaid, and private insurers. The convictions, announced by the Justice Department, revealed that the Kouza brothers billed for prescription medications that were never dispensed across multiple Michigan pharmacies they owned and operated.

The scheme resulted in significant financial losses to federal health care programs and private insurers, with Medicare, Medicaid, and Blue Cross Blue Shield of Michigan listed as victims. Their fraudulent billing practices involved false claims that led to the massive financial windfall until federal authorities intervened.

Convictions and Potential Sentencing for Defendants

The Kouza brothers’ convictions included charges of conspiracy to commit health care fraud and wire fraud. Additionally, Raad Kouza was found guilty of one count of health care fraud. Under federal law, they each face a maximum sentence of 20 years for the conspiracy count. Raad Kouza’s additional health care fraud charge carries a potential sentence of up to 10 years. Sentencing dates have not yet been determined and will be influenced by the U.S. Sentencing Guidelines.

The announcement of their conviction was made by Principal Deputy Assistant Attorney General Nicole M. Argentieri, 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). The FBI Detroit Field Office and HHS-OIG were responsible for the investigation, highlighting the ongoing commitment to combating health care fraud.

Nationwide Efforts to Crack Down on Health Care Fraud

This conviction is part of a broader effort by federal agencies to clamp down on health care fraud. The Health Care Fraud Strike Force Program, a key initiative under the Justice Department’s Criminal Division, has charged over 5,400 defendants for defrauding federal health care programs and private insurers out of more than $27 billion since its launch in 2007. The Centers for Medicare & Medicaid Services (CMS), alongside HHS-OIG, continue to implement measures aimed at holding providers accountable for fraudulent activities.

The Kouza brothers’ case serves as a stark reminder of the serious consequences associated with health care fraud and emphasizes the vigilance of federal agencies in protecting taxpayer-funded health care programs from abuse.

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