Source: United States Department of Justice Criminal Division

Four pharmacy owners have been sentenced for their roles in a conspiracy to commit health care fraud and wire fraud.

Pharmacist Raef Hamaed, of Maricopa County, Arizona, was sentenced on Jan. 8 to 10 years in prison; pharmacist Tarek Fakhuri, of Windsor, Ontario, Canada, was sentenced on Jan. 13 to seven years in prison; pharmacist Ali Abdelrazzaq, of Macomb County, Michigan, was sentenced on Jan. 15 to two years in prison; and pharmacist Kindy Ghussin, of Greene County, Ohio, was sentenced today to five years and five months in prison.

According to court documents and evidence presented at trial, Hamaed, Fakhuri, Ghussin, and Abdelrazzaq billed Medicare, Medicaid, and Blue Cross Blue Shield of Michigan for prescription medications that they did not dispense at five pharmacies they owned and operated: Eastside Pharmacy, Harper Drugs, and Wayne Campus Pharmacy in Michigan, and Heartland Pharmacy and Heartland Pharmacy 2 in Ohio. The defendants collectively caused over $13 million of loss to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan.

On Sept. 5, 2024, a federal jury convicted Hamaed, Fakhuri, Ghussin, and Abdelrazzaq of conspiracy to commit health care fraud and wire fraud. The jury also convicted Fakhuri of one count of health care fraud. Hamaed was sentenced for his role in the conspiracy at all five pharmacies; Fakhuri was sentenced for his role in the conspiracy at Harper Drugs, Wayne Campus Pharmacy, and Heartland Pharmacy; Ghussin was sentenced for his role in the conspiracy at Wayne Campus Pharmacy and both Heartland pharmacies; and Abdelrazzaq was sentenced for his role in the conspiracy at Wayne Campus Pharmacy.

Supervisory Official Antoinette T. Bacon 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.

The FBI Detroit Field Office and HHS-OIG investigated the case.

Trial Attorneys Claire Sobczak Pacelli, Kelly M. Warner, and S. Babu Kaza of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.

Source: United States Department of Justice Criminal Division

A grand jury in San Francisco returned an indictment yesterday charging a California man with filing false tax returns with the IRS.

According to the indictment, Michael M. Gilbert, of San Rafael, filed false tax returns for himself and two business entities he controlled. Gilbert, a Certified Public Accountant since 1985, allegedly underreported the total income his accounting and tax preparation business, M.M. Gilbert & Company Inc. (M.M. Gilbert), received during the years 2017 through 2020. Gilbert allegedly solicited payments from clients of M.M. Gilbert for “tax strategies” and “donations,” among other things, which the clients paid to White Mountain Properties Inc. (White Mountain), another entity Gilbert controlled. Gilbert allegedly did not report these payments as income on White Mountain’s 2017 through 2021 business tax returns. According to the indictment, in 2020 and 2021, Gilbert also transferred more than $5 million from White Mountain to himself and then did not report that income on his individual tax returns.

Gilbert is scheduled for his initial court appearance on Feb. 19 before U.S. Magistrate Judge Laurel Beeler for the Northern District of California. If convicted, Gilbert faces a maximum penalty of three years in prison for each count of filing a false tax return. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Acting Deputy Assistant Attorney General Karen Kelly of the Justice Department’s Tax Division made the announcement.

IRS Criminal Investigation is investigating the case.

Trial Attorneys Julia M. Rugg and Patrick Burns of the Tax Division are prosecuting the case.

An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Source: United States Department of Justice Criminal Division

A grand jury returned an indictment yesterday charging a Maine man with preparing false tax returns for clients and scheming to defraud clients, among other crimes.

According to the indictment, Musese, a paid return preparer, ran a tax preparation business out of a barbershop he owned and operated in Auburn, Maine. During the 2021 and 2022 tax years, Musese allegedly prepared and filed with the IRS false tax returns on behalf of 17 taxpayers. These tax returns allegedly included false business losses, fuel tax credits and residential energy credits, resulting in tax refunds these clients were not entitled to receive. For the 2023 tax year, Musese allegedly continued to prepare false tax returns for clients even after his electronic filing identification number was revoked by the IRS. According to the indictment, Musese also falsified his own tax returns for 2021 and 2022.

Musese also allegedly defrauded some of his clients by diverting to himself a portion of their tax refunds without their permission. According to the indictment, he provided these clients with copies of their tax returns that differed from the versions he filed with the IRS.

Musese will make his initial court appearance before a U.S. Magistrate Judge for the District of Maine at a later date. If convicted, Musese faces up to three years in prison for each count of filing a false tax return and a maximum penalty of up to 20 years in prison for each count of wire fraud. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Acting Deputy Assistant Attorney General Karen Kelly of the Justice Department’s Tax Division and U.S. Attorney Darcie N. McElwee for the District of Maine made the announcement.

IRS Criminal Investigation is investigating the case.

Trial Attorney Likhitha Butchireddygari of the Tax Division and Assistant U.S. Attorney Daniel Perry for the District of Maine are prosecuting the case.

An indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Source: United States Department of Justice Criminal Division

A Louisiana physician was sentenced yesterday to 87 months in prison for conspiring to illegally distribute over 1.8 million doses of Schedule II controlled substances, including oxycodone, hydrocodone, and morphine, and for defrauding health care benefit programs of more than $5.4 million.

According to court documents and evidence presented at trial, Adrian Dexter Talbot M.D., 59, of Slidell, owned and operated Medex Clinical Consultants (Medex), located in Slidell. Medex was a medical clinic that accepted cash payments from individuals seeking prescriptions for Schedule II controlled substances. Talbot routinely ignored signs that individuals frequenting Medex were drug-seeking or abusing the drugs prescribed. In 2015, Talbot took a full-time job in Pineville, Louisiana, and although he was no longer physically present at the Slidell clinic, he pre-signed prescriptions, including for opioids and other controlled substances, to be distributed to individuals there whom he did not see or examine. In 2016, Talbot hired another practitioner who, at Talbot’s direction, also pre-signed prescriptions to be distributed to individuals in exchange for cash deposited into a Medex bank account. The evidence also demonstrated that Talbot falsified patient records to cover up the scheme and to make it appear as though he was routinely examining the patients. With Talbot’s knowledge, these individuals filled their prescriptions using their insurance benefits, thereby causing health care benefit programs, including Medicare, Medicaid, and Blue Cross Blue Shield of Louisiana, to be fraudulently billed for controlled substances that were prescribed without an appropriate patient examination or determination of medical necessity.

On July 22, 2024, Talbot was convicted by a jury in the Eastern District of Louisiana of one count of conspiracy to unlawfully distribute and dispense controlled substances, four counts of unlawfully distributing and dispensing controlled substances, one count of maintaining a drug-involved premises, and one count of conspiracy to commit health care fraud.

Supervisory Official Antoinette T. Bacon of the Justice Department’s Criminal Division, the U.S. Attorney’s Office for the Eastern District of Louisiana, Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG), Special Agent in Charge Kris Raper of the Department of Veterans Affairs Office of Inspector General (VA-OIG)’s South Central Field Office, Assistant Director Chad Yarbrough of the FBI’s Criminal Investigative Division, Acting Special Agent in Charge Stephen A. Cyrus of the FBI New Orleans Field Office, and Louisiana Attorney General Liz Murrill made the announcement.

HHS-OIG, VA-OIG, FBI, and the Louisiana Medicaid Fraud Control Unit investigated the case.

Trial Attorneys Sara E. Porter and Gary A. Crosby II, Assistant Chief Justin Woodard, and Deputy Chief Kate Payerle of the Criminal Division’s Fraud Section prosecuted the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.