FOUR PEOPLE CHARGED IN $99 MILLION SCHEME TO COMMIT HEALTH CARE FRAUD AND WIRE FRAUD AND PAY KICKBACKS TO DOCTORS AND THEIR EMPLOYEES
TRENTON, N.J. – Four people have been charged for their roles in conspiracies to commit health care fraud and wire fraud and to pay kickbacks to doctors and doctors’ employees, U.S. Attorney Craig Carpenito announced today.
Alex Fleyshmakher, 33, of Morganville, New Jersey, was arrested this morning and will have his initial appearance this afternoon before U.S. Magistrate Judge Douglas Arpert in Trenton federal court. Also charged in the superseding indictment are: Ruben Sevumyants, 36, of Marlboro, New Jersey; and 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:
Prime Aid Pharmacies – now closed – operated as “specialty pharmacies” out of locations in Union City, New Jersey, and 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 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.
Initially, 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.
Starting in 2009, 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. The kickbacks included expensive meals and payments by cash, check, and wire transfers. Another method of bribery also involved paying an employee to work inside a doctor’s office for the doctor’s benefit.
Prime Aid Union City – at the direction of Shtindler, Khaimov, and Sevumyants – also engaged in the pervasive fraudulent practice of billing 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 superseding indictment charges each defendant as follows:
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.
U.S. Attorney Carpenito credited special agents of the FBI, under the direction of Special Agent in Charge Gregory W. Ehrie, in Newark; special agents of the Department of Health and Human Services-Office of Inspector General, under the direction of Scott J. Lampert; and the N.J. Office of the State Comptroller, Medicaid Fraud Division, under the direction of Director Josh Lichtblau, with the ongoing investigation leading to today’s arrest.
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.
The charges and allegations contained in the superseding indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.