by Natalie Mittelstadt
A former pharmacist was sentenced to 46 months in prison while another former pharmacist and his brother were sentenced to eight years and five years in prison, respectively.
The Justice Department is cracking down on healthcare fraud in Michigan, charging three people involved in two different schemes who stole a combined total of $20 million.
The DOJ has recently focused on instances of healthcare fraud in Michigan that resulted in tens of millions of dollars stolen from Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan. In addition to the recent cases resulting in years-long prison sentences, another case from over a decade ago just ended with the denaturalization of a woman from Venezuela who defrauded more than $5.4 million from Medicare while in Detroit.
Pharmacists abused trust, defrauded public
On Monday, Nabil Fakih, a former pharmacist who owned and operated a pharmacy in Dearborn Heights, Mich., was sentenced to 46 months in prison for his role in a healthcare fraud scheme, according to the DOJ. He was ordered to pay $4 million in restitution and to forfeit four real estate properties and $726,364.96.
From about 2011 to 2017, 50, Fakih, of Wayne County, billed Medicare for prescription medications that he did not dispense at his pharmacy, according to court documents. He submitted fraudulent claims for reimbursement to Medicare for high-reimbursing prescription medications, such as lung disease inhalers and blood thinners, that his pharmacy did not have the inventory to dispense.
Fakih concealed his fraudulent scheme by manipulating the inventory purchases at his pharmacy, as well as the receipt and transfer of the proceeds from the fraud, diverting the funds for his own personal use and benefit. In total, Fakih stole $4 million from Medicare. In August 2024, he pleaded guilty to one count of healthcare fraud at the U.S. District Court for the Eastern District of Michigan.
On Thursday, a former Michigan pharmacist and his brother were sentenced to eight years and five years in prison, respectively, for conspiracy to commit healthcare fraud and wire fraud, the DOJ announced Friday.
From about 2010 to 2019, a pharmacist, Raad Kouza, 59, of Wayne County, and his brother, a pharmacy manager, Ramis Kouza, 46, of Oakland County, billed Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan, according to court documents and evidence presented at trial.
The Kouzas billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for expensive medications, such as antipsychotics and inhalers, and concealed inventory shortages at their pharmacies from multiple auditors. Medicare, Medicaid, and Blue Cross Blue Shield of Michigan lost more than $15 million total due to the fraudulent scheme.
The two brothers were convicted of conspiracy to commit healthcare fraud and wire fraud by a federal jury in the U.S. District Court for the Eastern District of Michigan in November 2024. They were ordered by the court at sentencing to pay approximately $15.5 million in restitution and the same amount in forfeiture.
Immigrant clinic owner stripped of citizenship
A few days before the Kouzas' sentencing, on Nov. 17, a woman who was a naturalized citizen and pleaded guilty to conspiracy to commit healthcare fraud in 2012 was denaturalized, according to the DOJ.
The U.S. citizenship of Marieva Briceno, who defrauded more than $5.4 million from Medicare, was revoked after she obtained her citizenship by concealing her crimes from immigration officials.
Briceno, a Venezuelan native, owned three purported medical clinics in the Detroit area that paid people on Medicare to undergo unnecessary tests and procedures, per the DOJ. From May 2007 to January 2010, she and her co-conspirators submitted approximately $5,460,323 in fraudulent claims to Medicare for unnecessary medical services. Medicare ultimately paid $2,998,321.94 on those fraudulent claims, and Briceno personally received about $513,200 in fraudulent payouts.
Briceno applied for U.S. citizenship on Dec. 21, 2009, and on both her citizenship application and while under oath during an interview with immigration officials, she concealed her healthcare fraud and denied ever committing a crime for which she had not been arrested. As a result, she illegally procured her U.S. citizenship on March 19, 2010.
After the U.S. Attorney’s Office for the Southern District of Florida charged Briceno with healthcare fraud and conspiracy to commit healthcare fraud on Sept. 12, 2011, she pleaded guilty to the latter count on March 14, 2012, and was sentenced to 60 months in prison.
The DOJ on Aug. 12 sought Briceno’s denaturalization in the U.S. District Court for the Southern District of Florida based on her criminal conspiracy and failure to disclose it during her naturalization process. U.S. District Judge Darrin Gayles ordered the revocation of Briceno’s U.S. citizenship last week.
“The denaturalization of Marieva Briceno shows that if you steal from the programs that serve our most vulnerable citizens, you will be found out, prosecuted, and suffer the consequences of your actions, up to and including the loss of your U.S. citizenship,” Assistant Attorney General Brett A. Shumate of the DOJ's Civil Division said in a statement on Wednesday.
Natalie Mittelstadt
Source: https://justthenews.com/government/courts-law/doj-cracks-down-healthcare-fraud-michigan-charging-three-people-who-stole-20
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