Medical Fraud News:
Attorney General Letitia James:“It is disturbing and deeply damaging to our society when health care professionals exploit our most vulnerable patients to steal millions of dollars reserved to provide New Yorkers with essential health care.”
Attorney General Letitia James today announced the arrests of a New York City pharmacy owner and three of her managers for participating in a multi-million dollar Medicaid fraud scheme involving kickbacks and HIV drugs.
Pharmacy owner Irina Pichkhadze, 34, of Queens; and three of her pharmacy managers, Raymond Dieffenbacher, 46, of Queens, Yana Dubrinskaya, 31, of Brooklyn, and Tarlan (aka Boris) Pinkhasov, 40, of Queens, were all charged.
Pichkhadze’s pharmacy, Erri, Inc. d/b/a First Choice Pharmacy; and two additional companies, Express Audit Prevention Corp., and OTC Distributors, Inc., were all allegedly connected to crimes related to defrauding Medicaid out of more than $10 million in a kickback and drug diversion scheme through the First Choice Pharmacy located in Harlem.
“It is disturbing and deeply damaging to our society when health care professionals exploit our most vulnerable patients to steal millions of dollars reserved to provide New Yorkers with essential health care,” said Attorney General Letitia James. “We put our trust in medical providers to serve us with honesty and care, and these individuals took advantage of both that trust and our state. My office will continue to hold accountable those who forsake their professional responsibility to their patients and choose instead to use it to line their pockets with public funds.”
The four individual defendants along with First Choice Pharmacy were all charged today in Supreme Court with the crimes of Grand Larceny in the First Degree, two counts, Health Care Fraud in the First Degree, two counts, and Scheme to Defraud in the First Degree. Pichkhadze, Dieffenbacher, and Dubrinskaya were additionally charged, along with Express Audit and OTC, with various counts of money laundering in the first and second degree for allegedly knowingly conducting financial transactions designed to conceal the source of the aforementioned larceny and health care fraud. Lastly, Pichkhadze was charged with two counts of Criminal Possession of a Forged Instrument in the Second Degree for allegedly possessing two fake Department of State documents used to open bank accounts in connection with the money laundering charges. Pichkhadze, Dieffenbacher, and Pinkhasov were arraigned before Justice Gregory Carro. Dubrinskaya was arraigned before Justice Melissa Jackson. The next court date for all four individual defendants is August 1st.
Grand Larceny in the First Degree, Health Care Fraud in the First Degree, and Money Laundering in the First Degree are all class “B” felonies for which the maximum state prison sentence is 25 years. Money Laundering in the Second Degree, Criminal Possession of a Forged Instrument in the Second Degree, and Scheme to Defraud in the First Degree are, respectively, class “C”, “D”, and “E” felonies carrying maximum prison terms of 15, 7, and 4 years.
In court today, prosecutors from the Attorney General’s Medicaid Fraud Control Unit (MFCU) outlined a scheme in which the defendants, acting in concert with each other, allegedly paid or directed employees to pay cash kickbacks to Medicaid recipients in return for each patient’s agreement to fill their HIV prescriptions at Pichkhadze’s First Choice Pharmacy, located at 245 East 124th Street in Manhattan. First Choice Pharmacy in turn billed and eventually received hundreds of thousands of dollars from Medicaid for refills that First Choice Pharmacy either did not dispense to patients, a scheme known as “auto-refilling,” or were predicated on the payment of an unlawful kickback.
State law strictly prohibits all medical providers, including pharmacies, from paying or offering to pay cash kickbacks to anyone in return for the referral of medical services ultimately paid for by Medicaid.
Prosecutors further alleged today that their investigation found that between January 1, 2013 and December 31, 2016, Pichkhadze’s First Choice Pharmacy did not purchase sufficient quantities of medication from licensed New York State drug wholesalers to justify the quantities of medication it claimed, through its billing records, to have dispensed to patients. Relying on thousands of false claims for payment filed by Pichkhadze’s First Choice Pharmacy, Medicaid and Medicaid funded managed care organizations (MCOs) in turn paid First Choice Pharmacy and the individual defendants over $10.2 million dollars to which, prosecutors allege, they were not entitled.
Large sums of that money, prosecutors allege, were then funneled through pass through banks accounts, bearing the names of Express Audit, OTC, Minnesota Independant [sic] Drugs, and Azure Drugs., among others, and disguised as payments to pharmaceutical wholesalers. The latter two accounts were opened as assumed names for First Choice Pharmacy and in effect, prosecutors allege, the defendants funneled money back to themselves under the guise of inventory purchases.
During its investigation MFCU executed a search warrant at First Choice Pharmacy and recovered hundreds of bottles of allegedly adulterated, diverted HIV medication. State law requires pharmacies to only secure medication from licensed pharmaceutical wholesalers.
In conjunction with the criminal case, the Attorney General today also filed a civil asset forfeiture and New York State False Claims Act action against criminal defendants Pichkhadze, Dieffenbacher, Dubrinskaya, Pinkhasov, First Choice Pharmacy, Express Audit, and OTC as well as against three non-criminal defendants, Eduard Yagudayev, Janice Dieffenbacher, and Marina Pichkhadze. The asset forfeiture action and civil recovery action seeks to recover over $22 million dollars in damages from the defendants for defrauding the State Medicaid program.
The charges filed in this case are accusations. The defendants are presumed innocent until proven guilty in a court of law.
The Attorney General thanks the New York State Department of Health and Office of the Medicaid Inspector General as well as the United States Department of Health and Human Services, Office of the Inspector General (HHS-OIG) for their assistance in this investigation. The Attorney General also thanks Medicaid MCOs Amida Care and VNS Choice; pharmacy benefit managers CVS/Caremark, Express Scripts, Med Impact, and EPIC; and pharmaceutical wholesalers McKesson and DML Pharmacy Corporation for their cooperation throughout the investigation.
New Yorkers can report suspected fraud to the Attorney General’s toll-free Medicaid Fraud Hotline, at (800) 771-7755 or online at www.ag.ny.gov/medicaid-fraud/contact
MFCU’s investigation was conducted by Investigator Thomas Dowd with the assistance of Supervising Investigator Dominick DiGennaro and Deputy Chief Investigator Kenneth Morgan. The audit investigation was conducted by Auditor Investigator Lisandra Defex with the assistance of Principal Auditor Investigator Olga Sunitsky, New York City Regional Deputy Chief Auditor Jonathan Romano and New York City Regional Chief Auditor Thomasina Smith.
The criminal case is being prosecuted by Special Assistant Attorney General George Bronner and Edward Ferrity with assistance from Regional Director Christopher M. Shaw. Investigative support was provided by Confidential Legal Assistants Kelvin Caraballo and Chrisalys DeJesus. The civil action was handled by Special Assistant Attorney General Hillary Gray Chapman and Kathryn Heim Harris with the assistance of Civil Enforcement Chief Alee Scott. Special Assistant Attorney General Thomas O’Hanlon is the MFCU Chief of Criminal Investigations-Downstate. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division of Criminal Justice is led by Chief Deputy Attorney General for Criminal Justice José Maldonado.
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