Two Glen Head residents, Samuel Khaimov, 47, and Yana Shtindler, 44, were among four people facing federal charges in connection with a $99 million health care and wire fraud scheme. Two others, Ruben Sevumyants, 36, of Marlboro, NJ, and Alex Fleyshmakher, 33, of Morganville, NJ, were also arrested for their participation in the fraud scheme.
The participants worked out of Prime Aid Pharmacies, which had locations in Union City, NJ, and the Bronx. Prime Aid’s two locations have since gone out of business. The pharmacies had prepared and supplied specialty and expensive medications, which were prescribed to treat a number of conditions, including Hepatitis C, Crohn’s disease and rheumatoid arthritis.
Shtindler was the administrator for the Prime Aid Pharmacy in Union City. She also directed the tax preparations for the Prime Aid’s Bronx location. Khaimov was the lead pharmacist and co-owner of Prime Aid’s Union City location. Sevumyants was the operations manager of the Prime Aid in Union City. Fleyshmakher worked at the Prime Aid in Union City and was an owner of the Prime Aid in the Bronx.
At first, Prime Aid Pharmacies legally obtained agreements with several Pharmacy Benefit Managers (PBMs), which allowed them to receive reimbursement payments for specialty medications. The PBMs acted on behalf of health insurance companies, such as Medicare or Medicaid. When the pharmacy received a prescription, they submitted the claim for reimbursement to the PBM, which represented the recipient’s drug plan.
According to the indictment, from 2013-17, the Union City Prime Aid brought in more than $65 million in bogus reimbursement payments from Medicare, Medicaid and other private insurers. According to prosecutors, the medications were never in stock, never ordered and never given out to the patients. When other employees learned about the fraudulent activities, they were instructed by the defendants not to reverse the claims, despite the fact that the prescriptions or refills had not been given out.
When the benefit managers alerted Shtindler that prescriptions were being billed but not sent out, she allegedly told the PBMs and the healthcare providers that the pharmacy would take corrective measures to stop the fraudulent practices. Sevumyants allegedly began forging shipping records of a private commercial shipping company to make it seem as if medications were actually being sent out to the patients. Shtindler, Khaimov and Sevumyants were allegedly the decision makers in the process for billing and for the reimbursements for the pharmacy. Prosecutors state that the object of the conspiracy was for the defendants to “unlawfully enrich themselves by submitting and causing the submission of false and fraudulent claims to Medicare and Medicaid, among other healthcare programs.”
Beginning in 2009, the defendants Khaimov, Sevumyants, Fleyshmakher and other Prime Aid employees allegedly bribed doctors and the doctor’s employees to send more of their patients prescriptions to Prime Aid Pharmacies. The recipients received kickbacks, which included expensive meals ranging in upwards of $350, as well as cash, checks and wire transfers into the individuals’ bank accounts.
After some of the benefit managers stopped conducting business with Prime Aid Pharmacies, Khaimov and Shtindler opened new pharmacies, including Your Care in the Bronx. They transferred patients from the terminated Prime Aid Pharmacies to Your Care to continue making a profit.
According to an official press release from the U.S. Department of Justice (DOJ), Shtindler and Khaimov lied to the PBMs about the true ownership of those pharmacies, including Your Care, in order to ensure that in approving such pharmacies, the PBMs did not know the affiliation between the terminated pharmacies and the new pharmacies. This scheme resulted in one PBM being defrauded into paying Your Care more than $34 million in reimbursement payments. According to court documents, Shtindler and Khaimov diverted a portion of the illegal profits for their own personal use and to fund their tequila company.
The group faces numerous charges including health care fraud conspiracy, health care fraud, wire fraud conspiracy, wire fraud and kickback conspiracy. Each charge comes with a maximum sentence of 10 to 20 years in prison. According to the DOJ, all 10 counts are punishable by a $250,000 fine, or twice the gross gain or loss from the offense.