How a Michigan Pharmacist and His Brother Pulled Off a $15 Million Health Care Fraud Scheme
December 1, 2025 | JacobiJournal.com — health care and wire fraud. The duo orchestrated a complex scheme targeting Medicare, Medicaid, and private insurers, resulting in over $15 million in losses. The case underscores the persistent threat of health care fraud in pharmacies and the growing scrutiny by federal authorities. What the Fraud Entailed Federal investigators revealed that from 2010 to 2019, Raad Kouza, 59, and his brother Ramis Kouza, 46, submitted fraudulent claims for prescription medications they never dispensed at their Michigan pharmacies. Key points include: As a result, the scheme cost federal and private insurers more than $15 million. Why the Court Issued Prison Sentences In November 2024, a federal jury convicted the brothers of conspiracy to commit health care fraud and wire fraud. At sentencing: Federal prosecutors emphasized that these sentences reflect the severity of deliberate fraud targeting government health programs. How Federal Agencies Investigated the Case The case was investigated by the FBI Detroit Field Office and the HHS Office of Inspector General (OIG). It was prosecuted by the Criminal Division’s Health Care Fraud Strike Force Program, which has charged thousands of defendants nationwide for defrauding federal health programs. The DOJ notes that ongoing oversight by CMS and HHS-OIG aims to prevent similar fraud schemes and hold providers accountable. For readers seeking official details on health care fraud enforcement, visit the DOJ Health Care Fraud Unit. Why This Case Matters Experts say the Kouza case highlights systemic vulnerabilities in pharmacy billing and inventory oversight. It also demonstrates that coordinated federal investigation and prosecution can recover losses and deter future fraudulent activity. Health care providers are encouraged to strengthen internal audits, compliance programs, and reporting mechanisms to reduce exposure to similar legal risks. FAQ: Understanding Health Care Fraud by Pharmacists How do pharmacists commit health care fraud? Fraud can occur through billing for medications not dispensed, overcharging insurers, or falsifying inventory records, as demonstrated in this case. What are the penalties for health care fraud? Convictions can include prison time, restitution, forfeiture, and professional license sanctions, depending on the scale of the scheme. How are pharmacy fraud cases investigated? Federal authorities such as the FBI and HHS-OIG conduct audits, review billing records, and analyze pharmacy operations to detect discrepancies. Can victims recover losses from health care fraud? Yes. Courts often order restitution to recover losses for government programs and insurers impacted by fraudulent schemes. Stay informed on health care fraud and insurance investigations — subscribe to JacobiJournal.com for expert reporting and timely updates. 🔎 Read More from JacobiJournal.com: