N.J. U.S. Attorney: Pharmacy Operations Manager Admits Role in Multimillion-Dollar Health Care Fraud and Kickback Scheme

TRENTON, New Jersey, Aug. 19 -- The U.S. Attorney for the District of New Jersey, Philip R. Sellinger, issued the following news release on Aug. 18, 2023:

The former operations manager of a Union City, New Jersey, pharmacy today admitted his role in multimillion-dollar conspiracies to defraud health care insurers, including Medicare and Medicaid, and to pay kickbacks and bribes to health care professionals, U.S. Attorney Philip R. Sellinger announced.

Ruben Sevumyants, 40, of Marlboro, New Jersey, pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court to two counts of a superseding indictment charging him with conspiring to commit health care fraud and conspiring to violate the federal anti-kickback statute.

"This defendant admitted taking part in a scheme to steal millions of dollars from the health care system. From bribing doctors to billing for medication refills that were never provided, this conspiracy gamed the system, and Sevumyants profited along the way. He will now face the appropriate punishment for his crimes. Our office will always be on the lookout for those who try to turn our health insurance system into an ATM."

U.S. Attorney Philip R. Sellinger

"It can be hard to see why investigations like this matter to the general public going about their lives. However, healthcare professionals and pharmacies are meant to keep us healthy, not inflict harm. As healthcare recipients, we all end up footing the bills for fraudsters because our premiums increase to cover the cost of their crimes. We can't do it alone. We're asking anyone who is a victim of this type of fraud or sees it happening, to call us at 1-800-CALL-FBI and report it."

"New Jersey residents need to be able to trust their doctors and pharmacists are acting in the best interest of their overall health," Tammy Tomlins, Special Agent in Charge, IRS - Criminal Investigation, Newark Field Office, said. "By paying bribes to doctors to induce them to steer prescriptions to Prime Aid, Sevumyants helped to illegally enrich himself and others at Prime and this type of illegal activity erodes away at the trust we place in our medical professionals."

"Pharmacy employees who submit fraudulent claims to Medicare and Medicaid and bribe medical providers to induce prescriptions put health care benefits for older people and vulnerable populations at risk," Naomi Gruchacz, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), said. "HHS-OIG will continue to hold accountable individuals who exploit federal health care programs for their own greed."

Charges against two conspirators - Samuel "Sam" Khaimov and Yana Shtindler, both of Glen Head, New York - remain pending. Sevumyants's other conspirators in the kickback scheme are Igor Fleyshmakher, of Holmdel, New Jersey and Alex Fleyshmakher of Morganville, New Jersey. Alex Fleyshmakher previously pleaded guilty to his role in the conspiracy and is awaiting sentencing; Igor Fleyshmakher previously pleaded guilty and was sentenced in November 2021 to 41 months in prison.

According to documents filed in this case and statements made in court:

The Prime Aid Pharmacies - now closed - operated as "specialty pharmacies" in Union City, New Jersey, and Bronx, New York, processing expensive medications used to treat various conditions, including Hepatitis C, Crohn's disease, and rheumatoid arthritis. Sevumyants was Prime Aid Union City's operations manager. Khaimov was a co-owner of Prime Aid Union City and the lead pharmacist of Prime Aid Bronx. Khaimov's wife, Shtindler, was Prime Aid Union City's administrator. Alex Fleyshmakher worked at Prime Aid Union City and was an on-paper owner of Prime Aid Bronx. His father, Igor Fleyshmakher, was a co-owner of Prime Aid Union City.

Initially, the Prime Aid Pharmacies obtained retail network agreements with several pharmacy benefit managers (PBMs), which allowed them to receive reimbursement payments to prescription medications, including specialty medications. PBMs acted as intermediaries on behalf of Medicare, Medicaid, and private healthcare insurance providers, so that when a pharmacy received a prescription, the pharmacy then submitted a claim for reimbursement to the PBM that represented the beneficiary's drug plan.

Starting in 2009, to obtain a higher volume of prescriptions, Khaimov, Sevumyants, Alex Fleyshmakher, and other Prime Aid employees paid bribes to doctors and doctors' employees to induce doctors' offices to steer prescriptions to the Prime Aid Pharmacies. The bribes included expensive meals and payments by cash, check, and wire transfers. Another method of bribery also involved paying an employee to work inside a doctor's office.

Prime Aid Union City - at the direction of Sevumyants, Shtindler, and Khaimov - also engaged in the pervasive fraudulent practice of billing health insurance providers for medications that were never provided to patients. While Prime Aid generally provided medications for initial prescriptions it received, it systematically billed for refills for those same medications without ever dispensing them to patients. From 2013 through 2017, Prime Aid Union City received tens of millions of dollars in reimbursement payments from Medicare, Medicaid, and private insurers for medications that Prime Aid Union City not only failed to give patients, but never ordered or had in stock at the pharmacy.

PBMs conducted routine audits of Prime Aid Union City and discovered its practice of billing but not dispensing medications. In response to these audits, Shtindler instructed Prime Aid employees to falsify records submitted to the PBMs. Sevumyants, with Shtindler's knowledge and approval, forged shipping records of a private commercial shipping company to make it appear as if medications were shipped to the patients when they were not.

The conspiracy to commit healthcare fraud count is punishable by a maximum of 10 years in prison and the conspiracy to pay illegal kickbacks is punishable by a maximum of five years in prison. Both counts are also punishable by a $250,000 fine, or twice the gross gain or loss from the offense, whichever is greatest. Sentencing is scheduled for Dec. 20, 2023.

U.S. Attorney Sellinger credited special agents of the FBI, under the direction of Special Agent in Charge Dennehy in Newark; special agents of IRS-Criminal Investigation, under the direction of Special Agent in Charge Tomlins in Newark; special agents of the Department of Health and Human Services-Office of Inspector General, under the direction of Special Agent in Charge Gruchacz; the N.J. Office of the Insurance Fraud Prosecutor, Medicaid Fraud Unit, under the direction of Interim Insurance Fraud Prosecutor Al Garcia, and the N.J. Office of the State Comptroller, under the direction of Acting Comptroller Kevin Walsh, with the investigation leading to today's guilty plea.

The government is represented by Assistant U.S. Attorneys Joshua L. Haber, Chief of the Economic Crimes Unit and Aaron L. Webman of the Opioid Abuse Prevention and Enforcement Unit of the U.S. Attorney's Office in Newark.

The charges against and allegations in the information pertaining to Khaimov and Shtindler are merely accusations, and those two defendants are presumed innocent unless and until proven guilty.

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Original text here: https://www.justice.gov/usao-nj/pr/pharmacy-operations-manager-admits-role-multimillion-dollar-health-care-fraud-and