By ZEINAB NAJM
Times-Herald Newspapers
The U.S. Department of Justice four area residents for billing insurance for $9.2 million in medications that were not dispensed.
Wansa Nabih Makki, 41, of Dearborn and Mohamad Ali Makki, 43, of Dearborn Heights were indicted on multiple health care fraud offenses, while Mahmoud Makki, 36, and Hossam Tanana, 53, of Dearborn were indicted for laundering some of the proceeds of the health care fraud scheme, according to a U.S. Department of Justice press release.
If convicted, the defendants face a maximum of 10 years in prison and a $250,000 fine. Also, the defendants face a mandatory and consecutive two-year sentence if convicted of aggravated identity theft.
Wansa Makki owned LifeCare Pharmacy in Livonia and a second location in Farmington Hills where Pharmacist Mohamad Makki worked between January 2010 and January 2018, according to the indictment.
“Both pharmacies were ‘closed door’ pharmacies, meaning that they were not open to the public and only filled prescriptions for individuals associated with various care facilities,” the press release said.
According to the indictment, the pair billed Medicare, Medicaid and Blue Cross Blue Shield of Michigan for approximately $9.2 million for medications that were never dispensed.
The fraud scheme was detected by Medicare due to a huge deficit between each pharmacy’s recorded inventories and claims that each location submitted for insurance reimbursement.
“As part of the scheme to defraud, the defendants billed insurance companies for allegedly submitting claims for delivering over 500 medications to people who had died prior to the claimed date of delivery,” the press release said.
Of those claims, 371 between January 2010 and January 2016 and 147 claims from June 2015 and July 2018 were all made for medications purportedly dispensed to patients after their death to Medicare and Medicaid.
Proceeds of the fraud scheme were laundered by overpaying consulting and delivery companies operated by relatives, Mahmoud Makki and Tanana, according to the indictment and related criminal complaints.
“For instance, according to the complaints, Hossam Tanana was previously convicted for diverting controlled substances such as oxycodone, hydrocodone (Vicodin) and alprazolam (Xanax) while being licensed as a pharmacist,” the press release said. “Two days after being released from federal custody in April of 2012, Tanana incorporated a pharmacy consulting company.”
During a 14-month period beginning in December 2013, Tanana’s company received $400,000 from LifeCare Pharmacy and LifeCare Pharmacy also paid over $1 million to a delivery service opened by Wansa Makki’s brother, Mahmoud Makki, according to the indictment.
A complaint filed on April 5 in the U.S. District Court for Eastern District of Michigan claims that an audit was conducted in 2016 revealing that LifeCare Pharmacy had submitted multiple claims for allegedly dispensing expensive medications that were not supported by their known inventory. Mohamad Makki attempted to conceal the scheme by producing false invoiced created for the sole purpose of reconciling the record discrepancies, the complaint read.
Results from the audit also revealed that Medicare and Medicaid paid LifeCare Pharmacy almost $8.6 million between January 2010 and February 2016 and just over $616,000 from December 2015 and January 2018 for the medications allegedly dispensed.
The filed complaint alleges that Wansa Makki transferred approximately $1.1 million in health care proceeds by signing about 66 checks from a LifeCare Pharmacy bank account owned to a delivery company owned by Mahmoud Makki.
From January 2013 to July 2018, two Bank of America accounts connected to LifeCare Pharmacy received over $48 million in deposits from pharmacy benefit managers.
Wansa Makki received over $4.4 million in her personal account from the LifeCare Pharmacy accounts and fund indirectly from the pharmacy accounts which flowed through other business entities from December 2013 to at least August 2018, the complaint read.
The complaint also provided background on Tanana’s criminal record, stating he is a licensed pharmacist who was sentenced to 36 months in federal prison following a 2010 conviction for diverting controlled substances such as oxycodone, Vicodin and Xanax.
According to the U.S. Department of Justice, the case was investigated by Special Agents of Health and Human Services and FBI, with cooperation and assistance from the Michigan Department of Health and Human Services’ Office of Inspector General. Also, the case is being prosecuted by Assistant U.S. Attorneys John Engstrom, Philip Ross and Shankar Ramamurthy.
(Zeinab Najm can be reached at [email protected])