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Coalition Against Insurance Fraud

4 in Michigan charged in $9M Medicare fraud scheme

April 11, 2019, Farmington Hills, MI — A pharmacy owner and a pharmacist are being charged on multiple counts of healthcare fraud for billing insurance companies for medications that were never dispensed.

The Department of Justice announced charges against Mohamad Ali Makki and Wansa Nabi Makki in the case. In addition, Mahmoud Makki and Wansa Makki’s husband, Hossam Tanana, were charged.

Between January 2010 and January 2018, Wansa Makki oversaw two local pharmacies: LifeCare Pharmacy in Livonia and LifeCare of Michigan in Farmington Hills. According to the indictment, during that time they billed Medicare, Medicaid and Blue Cross Blue Shield of Michigan for $9.2 million in medications that were never dispensed.

The scheme was discovered by Medicare due to the huge deficit between the pharmacies’ inventories and claims submitted for reimbursement, the DOJ said. The defendants also billed insurance companies for more than 500 medications that were dispensed to people who were deceased.

Proceeds of the fraud were also laundered by overpaying consulting and delivery companies that were operated by relatives of Wansa and Mohamad Makki, according to the indictment. Tanana’s consulting company received more than $400,000 from LifeCare Pharmacy between the date of its incorporation until December 2013, the DOJ said.

The case was investigated by agents of the Department of Health and Human Services and the Federal Bureau of Investigation, with help from the Michigan Department of Health and Human Services. If found guilty, the defendants could receive a maximum sentence of 10 years in prison and a fine of $250,000. In addition, if convicted of identity theft, the defendants get a mandatory two-year sentence, the DOJ said.

The announcement of the indictment comes just days after the DOJ released news that the owner of several South Florida skilled nursing and assisted living facilities has been found guilty for his role in a $1.3 billion scheme to defraud Medicare and Medicaid.

In one of the largest healthcare fraud scams in U.S. history, Philip Esformes of Miami Beach was found guilty of bribing physicians to refer patients to his nursing facilities.

Source: Fierce Healthcare

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