Raad Kouza, Healthcare/Wire Fraud, Michigan 2024

Crime: In a shocking case of greed and deception, a former Michigan pharmacist and his brother have been sentenced to prison for their roles in a massive healthcare and wire fraud scheme that bilked Medicare, Medicaid, and Blue Cross Blue Shield of Michigan out of a staggering $15 million.

Raad Kouza, a 59-year-old pharmacist from Wayne County, and his brother, Ramis Kouza, a 46-year-old pharmacy manager from Oakland County, were convicted in November 2024 of conspiracy to commit healthcare fraud and wire fraud by a federal jury in the Eastern District of Michigan.

According to court documents and evidence presented at trial, the Kouza brothers 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. The defendants executed this fraud by targeting the billing of expensive medications, such as antipsychotics and inhalers, and by concealing inventory shortages at their pharmacies from multiple auditors.

As a result of their criminal conduct, the defendants caused a total of over $15 million loss to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. In a harsh punishment, Raad Kouza was sentenced to eight years in prison, while his brother Ramis Kouza was sentenced to five years in prison.

The defendants were also ordered to pay approximately $15.5 million in restitution and the same amount in forfeiture. The case was investigated by the FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG).

Acting Assistant Attorney General Matthew R. Galeotti of the Justice Department's Criminal Division praised the efforts of the investigators and prosecutors in bringing this case to justice. The Health Care Fraud Strike Force Program, led by the Criminal Division's Fraud Section, continues to combat healthcare fraud through a multi-agency effort.

The Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in healthcare fraud schemes. For more information on the Health Care Fraud Strike Force Program, visit www.justice.gov/criminal-fraud/health-care-fraud-unit.

Source: https://www.justice.gov/opa/pr/pharmacist-and-brother-sentenced-prison-15m-health-care-and-wire-fraud-scheme