Mich. U.S. Attorney: Pharmacy Owner Sentenced for Role in $9M Scheme to Bill Insurance for Medications Not Dispensed

DETROIT, Michigan, Jan. 21 -- The U.S. Attorney for the Eastern District of Michigan, Dawn N. Ison, issued the following news release on Jan. 20, 2022:

A licensed pharmacist from Dearborn Heights was sentenced to 77 months for his role in a scheme to defraud health care insurers by submitting claims for pharmaceuticals that were not actually purchased, announced United States Attorney Dawn N. Ison.

Ison was joined in the announcement by Acting Special Agent in Charge Josh Hauxhurst of the FBI's Detroit Division and Mario M. Pinto, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General.

Sentenced was Mohamad Ali Makki, 46. In sentencing Makki, United States District Judge Linda V. Parker ordered Makki to pay $9.8 million in restitution. Further, the court ordered the forfeiture of approximately $1.1 in funds seized from bank accounts controlled by Makki.

According to court records, from 2013 through 2019, Makki was a licensed pharmacist at Life Care Pharmacy in Farmington Hills. Makki, along with his co-conspirators Wansa Makki and Hossam Tanana, participated in a scheme to defraud Medicare, Medicaid and Blue Cross Blue Shield of Michigan by submitting claims for pharmaceuticals which Life Care Pharmacy did not actually purchase. Makki and his co-conspirators submitted claims for expensive pharmaceuticals such as Abilify, Seroquel, and Epipen 2-pak Injections. As part of the scheme and, in an effort to conceal the fraud from auditors, Makki created false invoices so that he could falsely claim to the auditors that LifeCare had, in fact, purchased the pharmaceuticals. In doing so, Makki and his co-conspirators caused more than $9.8 million in loss by obtaining reimbursements for the pharmaceuticals they never actually purchased.

"Fraud by health care professionals will be aggressively pursued by our office," said US Attorney Ison. "We hope that prosecutions like this one will deter health care professionals from stealing money from those who genuinely need it to order to line their own pockets."

"Healthcare fraud impacts the cost and availability of healthcare resources for every American," said Acting Special Agent in Charge Josh P. Hauxhurst of the FBI's Detroit Field Office. "We encourage the public to help us identify, investigate, and prosecute this crime. If you suspect healthcare fraud, report it to the FBI at [email protected], 1-800-CALL-FBI, or contact your health insurance provider."

"When pharmacists and other medical professionals enrich themselves by submitting fraudulent claims to Federal health care programs, they undermine the trust and confidence that beneficiaries and patients place in their hands," said Special Agent in Charge Mario M. Pinto. "Our agency will continue to hold medical professionals accountable, while protecting the programs intended for those that depend on them for life saving medication and critical services."

Co-defendant Hossam Tanana, 57, pleading guilty to money laundering proceeds obtained from the scheme in November 2021. He is awaiting sentencing. The remaining co-defendants, Wansa Makki, and Mahmoud Makki, are awaiting trial.

The case was investigated by Special Agents of the HHS and FBI, with cooperation and assistance from the Michigan Department of Health and Human Services - Office of Inspector General. The case is being prosecuted by Assistant U.S. Attorney Philip A. Ross.