Four Pharmacy Owners Convicted of $13 Million Insurance Fraud

The United States Department of Justice (DOJ) has announced the conviction of 4 pharmacy owners for conspiracy to commit health care fraud and wire fraud.

The Case

The complex case involved 4 pharmacy owners—3 in the US and 1 in Canada. The pharmacists were indicted on a scheme to defraud Medicare, Medicaid, and Blue Cross Blue Shield by submitting false and fraudulent prescriptions through their pharmacies in Michigan and Ohio for medications they did not dispense. Collectively, the defendants caused a loss of more than $13 million to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.

The pharmacist defendants included Raef Hamaed of Arizona, Kindy Ghussin of Ohio, Ali Abdelrazzaq of Michigan, and Tarek Fakhuri of Canada. All were licensed pharmacists who billed insurance for medications that were not dispensed. The DOJ alleged that the scheme ran from 2010 to approximately 2019, and that the pharmacists took steps to conceal the fraud.

The Convictions

The case went to trial before a federal jury. All 4 pharmacists were convicted of conspiracy to commit health care fraud and wire fraud. Additionally, Abdelrazzaq was convicted of 2 counts of health care fraud, and Fakhuri was convicted of 1 count of health care fraud. The defendants will be sentenced at a later date.

Potential Prison Time

The convicted pharmacists face a maximum penalty of 20 years in prison on the conspiracy count. Abdelrazzaq and Fakhuri are facing an additional 10 years in prison for each health care fraud count. The exact sentences will be determined by a federal district judge after consideration of the US Sentencing Guidelines and other factors.

The Takeaway

The US government is highly motivated to prosecute health care fraud cases. The Health Care Strike Force Program, established in 2007, comprises 9 strike forces operating in 27 federal districts. To date, the program has charged over 5,400 defendants who have bilked the federal government’s health care programs and private insurers for more than $27 billion.

References

Pharmacists convicted of $13M medicare, medicaid, and private insurer fraud scheme. Press Release. Office of Public Affairs. Published September 6, 2024. Accessed October 22, 2024. https://www.justice.gov/opa/pr/pharmacists-convicted-13m-medicare-medicaid-and-private-insurer-fraud-scheme

US v Raef Hamaed, RPh; Tarek Fakhuri RPh; Kindy Ghussin; RPh, Ali Abdelrazzaq, RPh. No 20-cr-20162. US District Court Eastern District of Michigan Southern Division; 2024. https://www.govinfo.gov/content/pkg/USCOURTS-mied-2_20-cr-20162/pdf/USCOURTS-mied-2_20-cr-20162-6.pdf