Four Charged In $99M Health Care, Wire Fraud Scheme

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  TRENTON – Two individuals from New Jersey and two from New York have been charged for conspiring to commit health care fraud and wire fraud, and to pay kickbacks to doctors and doctors’ employees, announced US Attorney Craig Carpenito announced.

  Alex Fleyshmakher, 33, of Morganville, New Jersey, was arrested on Sept. 16. Also charged in the superseding indictment are: Ruben Sevumyants, 36, of Marlboro, New Jersey; Samuel “Sam” Khaimov, 47, and Yana Shtindler, 44, both of Glen Head, New York.

  Sevumyants was previously charged by indictment, and Khaimov and Shtindler were each previously charged by complaint.

  According to documents filed in this case, the now-closed Prime Aid Pharmacies operated as “specialty pharmacies” out of locations in Union City, New Jersey, and Bronx, New York. Prime Aid processed expensive medications used to treat various conditions, including Hepatitis C, Crohn’s disease, and rheumatoid arthritis.

  Fleyshmakher worked at Prime Aid Union City and was an owner of Prime Aid Bronx. Khaimov was an owner of Prime Aid Union City and the lead pharmacist of Prime Aid Bronx. Shtindler was Prime Aid Union City’s administrator, and Sevumyants was its operations manager.

  According to authorities, Prime Aid Pharmacies obtained retail network agreements with several pharmacy benefit managers (PBMs), which allowed them to receive reimbursement payments for prescription medications, including specialty medications. PBMs acted as intermediaries on behalf of Medicare, Medicaid, and private healthcare insurance providers, so that when a pharmacy received a prescription, the pharmacy then submitted a claim for reimbursement to the PBM that represented the beneficiary’s drug plan.

  Later, beginning in 2009, Khaimov, Sevumyants, Fleyshmakher, and other Prime Aid employees paid bribes and kickbacks to doctors and doctors’ employees in order to obtain a higher volume of prescriptions. These kickbacks included expensive meals, payments by cash, check, and wire transfers, and paying an employee to work inside a doctor’s office for the doctor’s benefit.

  Prime Aid Union City also billed health insurance providers for medications that were never provided to patients. While Prime Aid generally provided medications for initial prescriptions it received, it systematically billed for refills for those same medications without ever dispensing them to patients.

  From 2013 through 2017, Prime Aid Union City received over $65 million in reimbursement payments from Medicare, Medicaid, and private insurers for medications the pharmacy not only failed to give patients, but never even ordered or had in stock.

  PBMs conducted routine audits of Prime Aid Union City and discovered its practice of billing but not dispensing medications. In response to these audits, Shtindler instructed Prime Aid employees to falsify records submitted to the PBMs. Sevumyants forged shipping records of a private commercial shipping company to make it appear as if medications were shipped to the patients when, in fact, they were not.

  Despite these concealment efforts, some PBMs terminated the Prime Aid Pharmacies from their PBM networks. In order to continue profiting from these same PBMs, Khaimov and Shtindler opened new pharmacies, including Your Care Pharmacy in Bronx, New York, and transferred patients from the terminated Prime Aid Pharmacies to Your Care.

  To facilitate this scheme, Shtindler and Khaimov lied to the PBMs about the true ownership of those pharmacies, including Your Care, in order to ensure that in approving such pharmacies, the PBMs did not know the affiliation between the terminated pharmacies and the new pharmacies.   This scheme resulted in one PBM being defrauded into paying Your Care over $34 million in reimbursement payments.

  The individuals involved were charged with 10 counts of Health Care Fraud Conspiracy, Health Care Fraud, Wire Fraud Conspiracy, Wire Fraud, and Kickback Conspiracy.

  The healthcare fraud counts are each punishable by a maximum of 10 years in prison. The wire fraud counts are each punishable by a maximum of 20 years in prison. The conspiracy to pay illegal kickbacks is punishable by a maximum of five years in prison. All 10 counts are also punishable by a $250,000 fine, or twice the gross gain or loss from the offense.