A federal jury convicted two Michigan brothers, Raad and Ramis Kouza, for their role in a massive health care fraud operation that targeted Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. The scheme, which spanned from 2010 to 2019, involved submitting fraudulent claims for medications that were never dispensed.
Raad Kouza, a Wayne County pharmacist, and his brother, Ramis Kouza, of Oakland County, orchestrated the fraudulent billing activities through five pharmacies they operated in Michigan: ER Drugs, Seaway, Food Town, Rockwood, and St. Paul. According to the U.S. Department of Justice (DOJ), the brothers submitted false claims, defrauding the health care programs of more than $15 million.
The fraudulent activities included billing for prescriptions that the pharmacies did not have in stock, resulting in substantial overpayments. Investigators found that these overpayments exceeded $7 million, with over $1.2 million in Medicaid overpayments alone.
The fraudulent activity was first uncovered in 2016 during a civil investigation conducted by the Michigan Department of Health and Human Services (DHHS) Office of Inspector General. The investigation revealed a pattern of suspicious billing practices and inventory shortages at the Kouzas’ pharmacies. Despite being notified multiple times about discrepancies in their billing practices, the Kouzas continued their operations, leading to a federal criminal investigation.
In addition to the conspiracy to commit health care fraud and wire fraud charges, Raad Kouza was convicted on a separate health care fraud charge. Both defendants face up to 20 years in prison for conspiracy, and Raad Kouza faces an additional 10 years for the separate health care fraud charge.
The case highlights the serious consequences of health care fraud and the significant impact these schemes have on Medicare and Medicaid programs, which are designed to serve vulnerable populations.