Two California pharmacy owners were sentenced to 144 months in prison for their role in a massive healthcare fraud scheme wherein they defrauded Medicare and Cigna for 11.8 million in claims. Assistant Attorney General Brian A. Becnzkowski, from the Justice Departments’ Criminal Division, U.S. Attorney Nicola T. Hanna of the Central District of California, along with Special Agent in Charge Timothy DeFrancesca from the Department of Health and Human Services Office of the Inspector General L.A. Regional Office and several FBI law enforcement officers announced recently that they had indicted Aleksandr Suris, belonging to Sherman Oaks California, and Maxim Sverdlov, also of Sherman Oaks.
The two individuals were associates and, as per U.S. District Judge S. James Otero of the Central District of California, Suris was to serve 144 months in prison and pay restitution of an amount of $11,826,444 for his healthcare fraud to Medicare, and $17,109.39 to the government agency CIGNA. It was also decided that Suris would make immediate a partial restitution payment of $500,000. Meanwhile, Sverdlov would serve a sentence of 144 months as well as pay the same restitution to Medicare of $11,826,444.65 to Medicare. He was also ordered by the court to pay. $500,000 in partial restitution.
The sentencing came after a trial that lasted 11 days, wherein several law enforcement agencies presented their findings of how the two individuals made fraudulent claims of distributing medication and were reimbursed by Medicare and CIGNA. Both were awarded their imprisonment sentences for six counts of healthcare fraud along with conspiracy to commit money laundering on a large scale. Both individuals operated from Royal Care Pharmacy, which they were both co-owners of, in Hollywood. As per the evidence collected against them, Suris and Sverdlov had documentation referring to billing Medicare and CIGNA from 2012 to 2015, prescribing medication that the Pharmacy had not, in fact, purchased and distributed to Medicare or CIGNA beneficiaries.
According to the evidence, both Suris and Sverdlov hid their fraudulent activity by developing fake documents and invoices with other co-conspirators, which would make it seem as though Royal Care Pharmacy had purchased the medications in large amounts. They would then bill Medicare and CIGNA and use these fake documents to launder the reimbursement money through their additional co-conspirator. Nearly 11.8 million was thus submitted as part of fake claims to Medicare and CIGNA, of which there was no evidence of disbursement to patients. Both fraudsters were caught in their fraudulent processes when they were investigated by the IRS, and their bogus documents and invoices were quickly processed by experts who revealed the discrepancies showing amongst them. The case was brought forth and shared with the jury through the diligent efforts of the Medicare Fraud Strike Force, who were supervised by the Criminal Division’s Fraud Section. The U.S. Attorney’s Office for the Central District of California and the IRS was also involved in bringing the two criminals to justice.
The prosecution was led by Trial Attorney Robyn N. Pullio and Assistant Chief Daniel J. Griffin, belonging to the Fraud Section which leads the Medicare Strike Force mentioned before. The Medicare Strike Force in particular keeps a keen eye on pharmacy operations, and the two defendants were caught through their efforts in investigating the invoices and other documentation that had been faked. This case, among others of a similar nature, is given special attention in the U.S. especially given that theirs is a nature that affects already vulnerable lives. The culprits are prone to use resources that are medically necessary for the survival of many patients suffering from harrowing ailments and illnesses. Thereby, various law enforcement are quick to crack down on healthcare fraud.
Although cases of healthcare fraud affect the immediate community they are carried out in, there is intangible damage caused to other stakeholders. If you or anyone you know would like to know more about healthcare fraud and how to avoid the legal implications connected to the same, please feel free to contact the Healthcare Fraud Group on 888-402-4054 for a free consultation and legal assistance.