Pharmacist and brother convicted of $15M Medicare, Medicaid, and private insurer fraud scheme

A federal jury convicted a pharmacy owner and his brother today for conspiracy to commit health care fraud and wire fraud.

According to court documents and evidence presented at trial, Raad Kouza, a pharmacist in Wayne County, and his brother, Ramis Kouza, of Oakland County, billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at pharmacies they owned or operated in Michigan. 

The defendants collectively caused over $15 million of loss to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.

Raad Kouza and Ramis Kouza were convicted of conspiracy to commit health care fraud and wire fraud. Raad Kouza was also convicted of one count of health care fraud. Both defendants face a maximum penalty of 20 years in prison on the conspiracy count, and Raad Kouza faces a maximum penalty of 10 years in prison on the health care fraud count. 

A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Sentencing hearings will be set at a later date.

Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division; Special Agent in Charge Cheyvoryea Gibson of the FBI Detroit Field Office; and Special Agent in Charge Mario Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

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