Nerik Ilyayev, Health Care Fraud, New York 2023

A former pharmacy owner has been sentenced to four years in prison for his involvement in a multimillion-dollar health care fraud scheme that targeted the Medicare and Medicaid programs and private insurance companies in New York.

Nerik Ilyayev, 36, of Queens, New York, was sentenced to four years in prison for his role in the scheme, which involved submitting millions of dollars in fraudulent claims to the government health care programs and private insurers.

According to the U.S. Attorney's Office, Ilyayev owned and operated two different pharmacies in Manhattan and Queens, and used them to pay illegal kickbacks to low-income HIV patients to recruit them to fill prescriptions for expensive HIV medications. He then submitted fraudulent insurance claims to Medicare and Medicaid to cover the cost of the medications, which he did not actually dispense.

The scheme, which lasted from February 2021 to March 2022, resulted in Medicare and Medicaid collectively paying approximately $5.2 million in fraudulent claims for HIV medications to one of the pharmacies. In addition, the other pharmacy defrauded no-fault automobile insurance providers of approximately $1.2 million.

Ilyayev also used the identity of another person to own and operate the pharmacies, and unlawfully sold pharmaceuticals to other pharmacies that he had obtained from illegitimate sources.

Ilyayev was sentenced to four years in prison, three years of supervised release, and ordered to pay restitution and forfeit more than $6 million.

The case was handled by the Office's Illicit Finance and Money Laundering Unit, and Assistant U.S. Attorneys Cecilia E. Vogel and Thane Rehn are in charge of the prosecution.

The investigation was conducted by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, Office of the Inspector General, with assistance from the National Insurance Crime Bureau and the Investigations Medicare Drug Integrity Contractor.

Source: https://www.justice.gov/usao-sdny/pr/pharmacy-owner-sentenced-four-years-prison-health-care-fraud