MARLBORO – A former operations manager of a New Jersey pharmacy admitted his role in a multimillion-dollar conspiracy to defraud health care insurers as well as pay kickbacks and bribes to health care professionals, officials said.
Ruben Sevumyants, 40, of Marlboro, pleaded guilty 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,” U.S. Attorney Philip R. Sellinger said. “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.”
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.
The Prime Aid Pharmacies operated as “specialty pharmacies” in Union City, New Jersey, and Bronx, New York, processing expensive medications used to treat various conditions. 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.
According to officials, “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.”
In order to obtain a higher volume of prescriptions, Khaimov, Sevumyants, Alex Fleyshmakher, and other Prime Aid employees paid bribes to doctors and doctors’ employees in 2009 to induce doctors’ offices to steer prescriptions to the Prime Aid Pharmacies. These bribes consisted of expensive meals and payments by cash, check, and wire transfers. Additionally, it 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, officials said.
“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,” officials said.
After PBMs conducted routine audits on the company, they discovered its practice of billing but not dispensing medications. In response, Shtindler made Prime Aid employees to fake records submitted to the PBMs. Sevumyants, with Shtindler’s knowledge and approval, forged shipping records of a private commercial shipping company to make it look 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 December 20.
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 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.
The post Pharmacy Manager Admits To Multimillion-Dollar Health Care Scheme appeared first on Jersey Shore Online.