A former Union City pharmacy operations manager has pleaded guilty to his role in a $34 million healthcare fraud and kickback scheme, U.S. Attorney Philip Sellinger announced.
By John Heinis/Hudson County View
Ruben Sevumyants, 40, of Marlboro, 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,” Sellinger said in a statement.
“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, and Alex Fleyshmakher of Morganville.
Alex Fleyshmakher previously pleaded guilty to his role in the conspiracy and is awaiting sentencing; Igor Fleyshmakher pleaded guilty in February 2020 and was sentenced in November 2021 to 41 months in prison.
The Prime Aid Pharmacies, now closed, operated as “specialty pharmacies” in Union City 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, and 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 December 20th.