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NJ Pharmacy Executives Plead Guilty in $65 Million Health Care Fraud Scheme

A sophisticated operation involving kickbacks, fraudulent billing, and manipulation of pharmacy benefit managers comes to light.

Trenton, NJSamuel “Sam” Khaimov and Yana Shtindler, key figures behind a Union City-based pharmacy, have admitted to their roles in a complex conspiracy defrauding pharmacy benefit managers and health care providers, including Medicare and Medicaid, of over $65 million. Their guilty pleas were entered before U.S. District Judge Michael A. Shipp in Trenton federal court, marking a significant development in a case that sheds light on the dark underbelly of healthcare fraud.

Khaimov, 52, pled guilty to charges of conspiring to commit healthcare fraud and violating the federal anti-kickback statute, while Shtindler, 48, admitted to conspiring to commit healthcare fraud. These admissions come as part of a larger investigation that has already seen their co-defendants, Ruben Sevumyants and Alex Fleyshmakher, plead guilty to related charges, awaiting their sentencing.

U.S. Attorney Philip R. Sellinger outlined the case as an egregious example of the lengths some will go to exploit the healthcare system for personal gain. By bribing health care professionals, falsifying records, and charging for undelivered medications, the defendants orchestrated a scheme that not only defrauded insurers of millions but also undermined the integrity of patient care.

The operation was centered around Prime Aid Pharmacies, which billed itself as a provider of specialty medications for serious conditions such as Hepatitis C and Crohn’s disease. Through a series of illicit tactics, including paying for inside access to doctors’ offices and engaging in fraudulent billing practices, the pharmacies amassed significant profits at the expense of Medicare, Medicaid, and private insurers.

The fraudulent activities extended to billing for medication refills that were never dispensed, a practice that saw Prime Aid Union City alone receive at least $65 million in unjust reimbursements between 2013 and 2017. When faced with audits, Shtindler and her team went as far as falsifying records and forging shipping documents to cover their tracks.

The legal consequences facing Khaimov and Shtindler include up to 10 years in prison for the healthcare fraud conspiracy charge, with the kickback conspiracy charge carrying a maximum of five years. Both are subject to fines up to $250,000 or twice the gross gain or loss from the offense, with sentencing scheduled for June 13, 2024.

This case highlights the collaborative efforts of federal and state agencies, including the FBI, IRS-Criminal Investigation, the Department of Health and Human Services-Office of Inspector General, and New Jersey’s Medicaid Fraud Unit, in bringing the perpetrators to justice. The actions of Khaimov, Shtindler, and their associates not only represent a significant breach of trust but also serve as a stark reminder of the ongoing battle against healthcare fraud and the importance of vigilance within the industry.

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