Two NJ Men Among Four Charged in $99M Health Care Scheme
Four people, including two from Marlboro, NJ, have been charged for their roles in conspiracies to commit health care fraud, wire fraud, and pay kickbacks to doctors and doctors' employees, announced U.S. Attorney Craig Carpenito.
Alex Fleyshmakher, 33, of Morganville was arrested on Monday and had his initial appearance before U.S. Magistrate Judge Douglas Arpert in Trenton federal court.
Ruben Sevumyants, 36, of Marlboro, New Jersey; and Samuel “Sam” Khaimov, 47, and Yana Shtindler, 44, both of Glen Head, New York were all indicted in the case.
Sevumyants was previously charged by indictment, and Khaimov and Shtindler were each previously charged by complaint.
Attorney Carpenito said that Prime Aid Pharmacies – now closed – operated as “specialty pharmacies” out of locations in Union City, New Jersey, and the Bronx, New York.
They 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 in the Bronx.
Khaimov was an owner of the Prime Aid in Union City and the lead pharmacist of Prime Aid in the Bronx.
Shtindler was Prime Aid Union City’s administrator, and Sevumyants was its operations manager.
Carpentio said that at first Prime Aid Pharmacies obtained retail network agreements with several pharmacy benefit managers (PBM's), which allowed them to receive reimbursement payments for prescription medications, including specialty medications.
PBM's 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.
The scheme started ten years ago when in order to obtain a higher volume of prescriptions, Khaimov, Sevumyants, Fleyshmakher, and other Prime Aid employees paid bribes and kickbacks to doctors and doctors’ employees to induce them to steer prescriptions to Prime Aid Pharmacies.
Those kickbacks included expensive meals and payments by cash, check and wire transfers and paying an employee to work inside a doctor’s office for the doctor’s benefit.
The Prime Aid in Union City also allegedly engaged in the pervasive fraudulent practice of billing health insurance providers for medications that were never provided to patients.
While Prime Aid provided medications for initial prescriptions it received, they billed refills for those same medications without dispensing them to the patients.
From 2013 through 2017, the Prime Aid Pharmacy in 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.
PBM's conducted routine audits of Prime Aid in Union City and they 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 then allegedly forged shipping records of a private commercial shipping company to make it appear as if medications were shipped to the patients.
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.
Khaimov, Shtindler and Sevumyants are charged with one count of Health Care Fraud Conspiracy, two-five counts of Health Care Fraud and ten counts of Kickback Conspiracy.
Khaimov and Shtindler were also charged with six counts of Wire Fraud Conspiracy and Wire Fraud.
The healthcare fraud counts charged in Counts One through Five are each punishable by a maximum of 10 years in prison.
The wire fraud counts charged in Count Six through Nine are each punishable by a maximum of 20 years in prison.
The conspiracy to pay illegal kickbacks charged in Count 10 in 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.
The government is represented by Assistant U.S. Attorney Joshua L. Haber of the Health Care & Government Fraud Unit, and Senior Trial Counsel Jason S. Gould of Criminal Division of the U.S. Attorney’s Office in Newark.
Khaimov: Anthony Iacullo Esq., Nutley, New Jersey.
Shtindler: Lawrence S. Lustberg Esq., Newark.
Sevumyants: Amy Luria Esq. & Michael Critchley Sr. Esq., Roseland.