To Dispense or Not to Dispense

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Confident Doctor shaking hands with patients talk in the hospital

Mohamad Ali Makki, 46, of Dearborn Heights, Mich., participated in a healthcare fraud scheme that defrauded Medicare, Medicaid, and Blue Cross Blue Shield of Michigan of nearly $10 million. As a licensed pharmacist at LifeCare Pharmacy in Farmington Hills over six years, Makki and his co-conspirators, Wansa Makki and Hossam Tanana, submitted claims for pharmaceuticals that were not actually purchased, nor dispensed. (LifeCare pharmacy was not open to the public. It filled prescriptions for individuals associated with various care facilities.)

The claims submitted by Makki and his co-conspirators were for expensive pharmaceuticals

(Abilify, Seroquel, and Epipen 2-pak Injections, just to name a few.) According to court records, claims were submitted for delivering more than 500 medications to people who were deceased prior to the claimed date of delivery.

To conceal the fraudulent activity from auditors, the devious trio created false invoices claiming that Life Care Pharmacy did purchase these pharmaceuticals. (These fraudsters received $9.8 million in reimbursements from the government healthcare programs and Blue Cross Blue Shield of Michigan.)

Makki was sentenced to 77 months in prison for his role in the healthcare fraud scheme. He was also ordered to pay $9.8 million in restitution and must forfeit approximately $1.1 million in funds seized from bank accounts that he controlled.

Co-defendant Hossam Tanana, 57, who pleaded guilty to money laundering proceeds obtained from the scheme, awaits sentencing. The remaining co-defendants are also awaiting trial. (I’m sure that the judge will dispense an appropriate sentence for the remaining co-defendants.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Pharmacy Owner Sentenced for Role in $9 Million Scheme to Bill Insurance for Medications Not Dispensed,” dated January 20, 2022. 

DETROIT – 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.

 

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.