Wayne and Oakland County Brothers Found Guilty in $15M Medicare and Medicaid Fraud Scheme

A Wayne County pharmacist and his Oakland County brother have been found guilty by a federal jury on charges of conspiracy to commit health care fraud and wire fraud, with the pharmacist, Raad Kouza, also convicted of an additional health care fraud charge, according to

The Detroit News

. This case has highlighted the continuing issue of health insurance fraud in the region, with the Kouza brothers’ actions causing more than $15 million in losses to Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. The pharmacist owned and operated several pharmacies in the state, including ER Drugs and Seaway Pharmacy in Taylor and Foodtown Drugs in Monroe.

Sentencing for Raad and Ramis Kouza has yet to be scheduled. However, they both could face substantial prison time, with Raad Kouza potentially looking at a maximum of 30 years and Ramis Kouza up to 20 years, as reported by

ClickOnDetroit

. They were charged in September 2020, and their scheme, which involved billing for prescription medications that were not dispensed, operated from about 2010 through 2019. The fraudulent activities by the Kouza brothers come as part of a wider scope of health insurance fraud cases in the area, which in recent years have included a Macomb County couple and six individuals with Michigan ties who were charged federally in various scams.

According to the

U.S. Department of Justice

, the case was investigated by the FBI Detroit Field Office and the Department of Health and Human Services Office of Inspector General, with the trial being prosecuted by members of the Criminal Division’s Fraud Section. The Fraud Section leads efforts to combat healthcare fraud through the Health Care Fraud Strike Force Program, which has been operational since March 2007 and has charged thousands of defendants who have collectively billed federal healthcare programs and private insurers an excess of $27 billion.

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