The possessors and managers of a chemist situated in Los Angeles were both convicted on 26th February 2020 to 144 months in federal prison for their participation in a health care fraud plot where CIGNA and Medicare were charged over 11.8 million USD in fraudulent allegations for prescription medication.
The announcement was reported by Special Agent in Charge of the U.S. Department of the HHS-OIG(Health and Human Services-Office of Inspector General) Los Angeles Regional Office Timothy DeFrancesca, U.S. Attorney for California’s Central District Nicola T. Hanna, Special Agent in Charge of the California Department of Justice Kris Kyle, Assistant Attorney General of the Justice Department’s Criminal Division Brian A. Benczkowski, Special Agent in Charge of the IRS-CI (IRS-Criminal Investigation) Los Angeles Field Office Ryan L. Korner, and Assistant Director Paul D. Delacourt in Charge of the FBI’s Los Angeles Division.
Aleksandr Suris, age 51, from Sherman Oaks, California, was convicted to 144 months in federal prison by U.S. District Judge of the Central District of California, S. James Otero, who also directed Suris to remit restitution of 17,109.39 USD to CIGNA and 11,826,444.65 USD to Medicare. The court directed Suris to make an instant partial remuneration remittance of 500,000 USD. Maxim Sverdlov, age 45, also from Sherman Oaks, California, was convicted to 144 months in federal prison by Judge Otero, who directed him to remit a remuneration of 11,826,444.65 USD to Medicare. The court directed Sverdlov to make an instant partial remuneration remittance of 500,000 USD.
On 29th August 2019, proceeding an eleven-day case, a jury found Suris guilty of 6 counts of health care fraud, a single count of conspiracy to perpetrate money laundering, and double counts of conspiracy to perpetrate health care fraud. The jury found Sverdlov guilty of a single count to perpetrate money laundering and a single count of conspiracy to perpetrate health care fraud.
Suris and Sverdlov were co-proprietors and co-managers of Royal Care (Royal Care Pharmacy) in Hollywood. As per the documents submitted at the proceeding, from 2012 to 2015, Suris and Sverdlov fraudulently charged CIGNA and Medicare for prescription drugs that Royal Care did not really buy or distribute to recipients. In order to disguise the plot, Suris and Sverdlov acquired fake medication invoices to make it look as if Royal Care had bought the drugs for which it had charged CIGNA and Medicare when in reality, it did not. In summation, Suris and Sverdlov presented over 11.8 million USD in falsified claims to Medicare for prescription medication that they did not buy or distribute to patients.
The investigation for the case was conducted by the California Department of Justice, IRS-CI, HHS-OIG, and the FBI, and was brought as a section of the Medicare Fraud Strike Force, under the direction of the U.S. Attorney’s Office for the Central District of California and the Criminal Division’s Fraud Section. The prosecution was handled by Assistant Chief Daniel J. Griffin of the Fraud Section and Trial Attorney Robyn N. Pullio.
The Medicare Fraud Task Force is guided by the Fraud Section. As from its formation in March 2007, the Medicare Fraud Task Force, which continues with fifteen strike forces running in twenty districts, has indicted over 4,200 defendants who accumulatively charged the Medicare program approximately 19 billion USD. Further, the Department of Health and Human Services Centers for Medicaid and Medicare Services, working together with the U.S. Department of Health and Human Services-Office of Inspector General, are taking action to expand liability and reduce the existence of fraudulent health care providers.
You risk a severe imprisonment sentence and hefty fines if found guilty of breaching the False Claim Statute, Anti-Kickback Statute, or the Controlled Substance Act. Plotting to commit health care fraud by swindling state-sponsored programs such as TRICARE or Medicaid could also have you locked up in the big house as fast. Individuals accused of committing the above crimes are treated as lawbreakers, and they can face severe punishment when and if found guilty. When charged with any health care fraud-related offenses, seeking the services of an excellent and experienced legal team is a matter of when not if.
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