$15M Health Care Fraud: Michigan Brothers Face Prison for Defrauding Medicare, Medicaid
A Michigan pharmacy owner and his brother were convicted on Friday by a federal jury for conspiracy to commit health care fraud and wire fraud, following a thorough investigation that uncovered fraudulent activity affecting Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.
Raad Kouza, a pharmacist from Wayne County, and his brother Ramis Kouza, from Oakland County, were found guilty of running a fraudulent scheme from 2010 to 2019, submitting claims to health care programs for medications that were never dispensed. The brothers operated through five pharmacies in Michigan—ER Drugs, Seaway, Food Town, Rockwood, and St. Paul—submitting false claims for prescriptions they had no inventory to fulfill. Investigators determined that their scheme defrauded the health care programs of over $15 million, with more than $7 million in overpayments, including $1.2 million from Medicaid.
The fraud was first detected in 2016 during a civil investigation by the Michigan Department of Health and Human Services Office of Inspector General, which revealed suspicious billing practices and major inventory shortages at the pharmacies. Despite warnings about the discrepancies, the brothers continued the fraudulent activity, leading to a federal criminal investigation and charges.
Raad Kouza was convicted on an additional charge of health care fraud, while both brothers were found guilty of conspiracy to commit health care fraud and wire fraud. They each face up to 20 years in prison for the conspiracy charge, with Raad Kouza facing an additional 10 years for the health care fraud conviction.
