Four people have been charged in a $99 million pharmacy fraud scheme.
The Department of Justice announced that four people connected with the defunct New York and New Jersey pharmacy group Prime Aid Pharmacies had been charged in a scheme that involved paying kickbacks to physicians and falsifying documents to fraudulently bill for medications that were not dispensed to patients.
Alex Fleyshmakher, 33, of Morganville, New Jersey, was arrested and charged Monday, while Ruben Sevumyants, 36, of Marlboro, New Jersey; Samuel Khaimov, 47, of Glen Head, New York; and Yana Shtindler, 44, also of Glen Head, had previously been charged in the case, DOJ said.
Khaimov and Shtindler were each charged with one count of conspiracy to commit healthcare fraud, four counts of healthcare fraud, one county of conspiracy to commit wire fraud and three counts of wire fraud. Sevumyants was charged with one count of conspiracy to commit healthcare fraud and four counts of healthcare fraud, DOJ announced.
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Fleyshmakher, Sevumyants and Khaimov were each charged with one count of kickback conspiracy, according to DOJ.
According to the indictment, the co-conspirators worked at or owned two Prime Aid Pharmacies—Prime Aid Union City and Prime Aid Bronx—that operated as “specialty pharmacies,” processing costly drugs for conditions including hepatitis C and rheumatoid arthritis.
Prime Aid was able to secure network agreements with several pharmacy benefit managers that allowed it to earn reimbursements from both federal and private payers, DOJ said. Beginning in 2009, the co-conspirators and other employees at the pharmacies would pay kickbacks and bribes to physicians to encourage them to direct additional prescriptions to their locations, according to DOJ.
These kickbacks included pricey meals and payments by check, cash and wire transfer, according to the announcement. Prime Aid also bribed physicians by paying an employee to work in the doctors' offices, DOJ said.
Prime Aid would generally fill the first prescription for patients and then bill refills without providing the medications, according to DOJ. Between 2013 and 2017, the company received $65 million in reimbursements for drugs that they not only failed to provide to patients but that they never stocked or ordered.
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PBMs contracting with the pharmacies conducted an audit that identified the fraudulent billing, according to DOJ, which led to some canceling their contracts. To save their remaining contracts, Shtindler directed employees to submit falsified records to PBMs, DOJ said, and Sevumyants forged shipping documents to make it appear as though drugs were sent to patients.
Khaimov and Shtindler also opened new pharmacies to continue billing payers, according to DOJ, and transferred patients from Prime Aid pharmacies. The pair lied to insurers about ownership of the new pharmacies, which included Your Care Pharmacy in the Bronx, according to the indictment.
The scheme resulted in $34 million in fraudulent payouts from just one PBM that contracted with the new pharmacies, DOJ said.