A former Union City pharmacy co-owner administrator, a husband and wife, have admitted their roles in a $65 million kickback and bribery scheme, U.S. Attorney Philip Sellinger announced.
By John Heinis/Hudson County View
Samuel “Sam” Khaimov, 52, and his wife, Yana Shtindler, 48, both of Glen Head, New York, pleaded guilty before U.S. District Judge Michael A. Shipp in Trenton federal court on Wednesday.
Khaimov 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. Shtindler pleaded guilty to conspiring to commit health care fraud.
Khaimov and Shtindler’s codefendants, Ruben Sevumyants of Marlboro, and Alex Fleyshmakher of Morganville, have already pleaded guilty to counts in the superseding indictment and are awaiting sentencing.
“These defendants admitted taking part in an elaborate and years-long scheme to use their specialty pharmacy to rip off Medicare, Medicaid and private insurers. They paid bribes, kickbacks, set up phony jobs in doctors’ offices,” Sellinger said in a statement.
“They took reimbursements for medications that never dispensed and falsified records, defrauding insurers via pharmacy benefits managers of more than $65 million. Protecting the integrity of our healthcare system at all levels is a top priority for this office. We will continue to work relentlessly with our enforcement partners to ensure those who commit healthcare fraud or undermine the integrity of medical decision-making through bribes and kickbacks face justice, like the defendants in this case.”
The Prime Aid Pharmacies – now closed – operated as “specialty pharmacies” out of locations in Union City and the Bronx, New York. As specialty pharmacies, they processed expensive medications used to treat various conditions, including Hepatitis C, Crohn’s disease, and rheumatoid arthritis.
Khaimov was a co-owner of Prime Aid Union City and the lead pharmacist of Prime Aid Bronx. Shtindler was Prime Aid Union City’s administrator.
Sevumyants was Prime Aid Union City’s operations manager. Alex Fleyshmakher worked at Prime Aid Union City and was an on-paper owner of Prime Aid Bronx.
His father, Igor Fleyshmakher, a co-owner of Prime Aid Union City, pleaded guilty to separate federal charges.
Initially, the Prime Aid Pharmacies obtained retail network agreements with several pharmacy benefits managers (PBM), which allowed them to receive reimbursement payments for prescription medications, including specialty medications.
PBMs acted as intermediaries on behalf of Medicare, Medicaid, and other health benefit providers, so when one of the Prime Aid Pharmacies received a prescription, the pharmacy would typically submit 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 the doctors and their staffs to steer prescriptions to the Prime Aid Pharmacies.
The bribes included payments by cash, check, and wire transfers, as well as expensive meals and other things of value. Another method of bribery 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 and fraudulent practice of billing health benefit providers and PBMs 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.
According to the superseding indictment, from 2013 through 2017, Prime Aid Union City received at least $65 million in reimbursement payments from Medicare, Medicaid, and private health benefit providers for medications that Prime Aid Union City not only failed to give patients, but that Prime Aid Union City also never even ordered or had in stock at the pharmacy.
Over time, 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 PMBs.
In addition, 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, in fact, they were not.
The conspiracy to commit healthcare fraud count is punishable by a maximum of 10 years in prison, while 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. Their sentencing is scheduled for June 13th.
