A federal jury has found two brothers guilty of orchestrating a health care fraud scheme involving Medicare, Medicaid, and private insurers. Raad Kouza, a pharmacist from Wayne County, Michigan, and his brother Ramis Kouza from Oakland County, Michigan, were convicted of conspiracy to commit health care fraud and wire fraud. The pair were accused of billing for prescription medications that were never dispensed at their Michigan pharmacies.
The fraudulent activities led to losses exceeding $15 million for Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. Besides the conspiracy charges, Raad Kouza was also found guilty of one count of health care fraud. Both face up to 20 years in prison for the conspiracy charge. Additionally, Raad Kouza could receive a maximum penalty of 10 years for the health care fraud charge. Sentencing will be determined by a federal district court judge after considering relevant guidelines and statutory factors.
The announcement was made by Principal Deputy Assistant Attorney General Nicole M. Argentieri from the Justice Department’s Criminal Division; Special Agent in Charge Cheyvoryea Gibson from the FBI Detroit Field Office; and Special Agent in Charge Mario Pinto from the Department of Health and Human Services Office of Inspector General (HHS-OIG).
The case was investigated by the FBI Detroit Field Office and HHS-OIG. Trial Attorneys Claire Sobczak Pacelli, Jeffrey A. Crapko, and Andres Q. Almendarez from the Criminal Division’s Fraud Section are leading the prosecution.
This conviction is part of broader efforts by the Fraud Section's Health Care Fraud Strike Force Program to combat fraudulent activities within health care systems since its inception in March 2007. The program has charged over 5,400 defendants involved in billing more than $27 billion to federal programs and private insurers.
For further details on these efforts against health care fraud schemes, visit www.justice.gov/criminal-fraud/health-care-fraud-unit.