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A Brooklyn pharmacist arrested in March by Federal Bureau of Investigation (FBI) agents following an OMIG-assisted investigation was convicted in federal court last week for conspiring to illegally distribute oxycodone and commit Medicaid fraud.
Kian Gohari, pharmacist and owner of Ekwunife Pharmacy in Brooklyn, New York, was convicted of one count of conspiracy to distribute narcotics and one count of conspiracy to commit healthcare fraud following an eight-day trial in U.S. Southern District of New York court. According to evidence presented by prosecutors during the trial, Gohari distributed more than 25,000 medically unnecessary oxycodone pills between 2012 and 2015 and fraudulently sought hundreds of thousands of dollars in Medicaid reimbursement for the distributions. Gohari faces a maximum sentence of 30 years in prison for his role in the scheme and is scheduled for sentencing before U.S. District Judge Jed S. Rakoff.
“Prescription medication abuse is illegal, potentially fatal, and continues to devastate countless communities across the nation,” Medicaid Inspector General Dennis Rosen said. “We will continue to assist the FBI and other law enforcement agencies to hold individuals accountable for their actions if they use the Medicaid program to exploit those suffering with addiction for profit.”
Per court documents, Gohari was one of five individuals who were arrested and charged in March for partaking in the oxycodone prescription ring. It was alleged that Gohari’s four other drug trafficking co-conspirators visited doctors’ offices to receive prescriptions for oxycodone that they did not intend to use, filled those prescriptions at Gohari’s Pharmacy, and then distributed the oxycodone pills to purchasers in the New York metropolitan area. As part of the illegal prescription ring, Gohari additionally received prescriptions from his co-conspirators for high-end HIV, psychiatric, and pain gel medication, to which he also illegally billed the Medicaid program.
The scheme was foiled following an investigation in which OMIG investigators provided critical evidence to the FBI, NYPD, and other federal, state, and local law enforcement agencies involved in the case.
New York State Office of the Medicaid Inspector General
Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
Help us fight fraud, waste and abuse: OMIG Fraud Hotline: 1-(877) 87-FRAUD/1-(877) 873-7283
For more news and information, like OMIG on Facebook and follow us on Twitter: @nysomig
The New York State Office of the Medicaid Inspector General (OMIG) has released its 2015 Annual Report, which details New York's Medicaid program integrity efforts for 2015. Results include:
- More than $1.8 billion in avoided costs to the Medicaid program
- Recoveries of more than $340 million
- Over the last four years, Medicaid recoveries and cost-savings efforts have exceeded $10.2 billion
View the report here: https://www.omig.ny.gov/images/stories/annual_report/2015_annual_report.pdf
The NYS Attorney General's office filed felony criminal charges against a Nyack woman who allegedly submitted nearly $2 million in fraudulent substance abuse treatment service claims for reimbursement to the Medicaid program and to the state-funded Medicaid Managed Care Organization (MCO), MetroPlus. The arrest results from an investigation in which the Office of the Medicaid Inspector General (OMIG) played a key role.
Natalia Dochim, 39, of Nyack, New York and her two companies, Miromedical P.C. and Ferrara Medical Care, P.C., were charged following Dochim's arrest Wednesday, according to papers filed in New York City Criminal and New York State Supreme Courts, Bronx County. Dochim, charged with grand larceny, health care fraud, and money laundering, faces up to 25 years in prison if convicted on all charges.
"Attempting to profit by luring Medicaid recipients who suffer from addiction into fake treatments during a national opioid epidemic is dangerous and deplorable," Medicaid Inspector General Dennis Rosen said. "We will continue to work closely with our partners in the Attorney General's office and law enforcement to hold fully accountable individuals who seek to profit at the expense of New York's most vulnerable citizens."
Prosecutors charge that Dochim and her co-conspirators at Miromedical P.C. and Ferrara Medical Care, recruited Medicaid patients by offering cash-kickbacks and prescription narcotics, and then subjected the patients to sham medical tests, unnecessary treatments, or treatments not approved for opioid addiction. These services, as well as other fabricated medical services, were alleged to have been submitted for reimbursement to MetroPlus and the Medicaid program, with the revenue generated from the fraudulent claims laundered through various shell companies.
The charges filed in this case are accusations. The defendant is presumed innocent until proven guilty in a court of law.
More about this arrest as well as OMIG's efforts is available at: http://ag.ny.gov/press-release/ag-schneiderman-announces-arrest-clinic-operator-allegedly-defrauding-medicaid
New York State Office of the Medicaid Inspector General
Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
Help us fight fraud, waste and abuse: OMIG Fraud Hotline: 1-(877) 87-FRAUD/1-(877) 873-7283
For more news and information, like OMIG on Facebook and follow us on Twitter: @nysomig
The New York State Office of the Medicaid Inspector General (OMIG) today posted on its website Compliance Program Review Guidance, which details what OMIG looks for when assessing compliance programs required under New York State Social Services Law § 363-d and 18 NYCRR Part 521.
The extensive Guidance addresses all requirements under each of the eight elements as well as the seven prime risk areas, which include billing, payment, medical necessity and quality of care, governance, mandatory reporting, credentialing, and other risk areas. This Guidance is not intended to replace any prior guidance offered by OMIG.
The Compliance Program Review Guidance is available at: https://omig.ny.gov/images/stories/compliance/compliance_program_review_guidance.pdf
Please direct any questions to OMIG's Bureau of Compliance at 518-408-0401 or via email at compliance@omig.ny.gov. Please include "CPR Guidance" in the subject line of the email.
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- Home Care Scheme Leads to Arrest of Rochester Man
You can help stop Medicaid fraud.
Call OMIG’s Fraud Hotline at:
1-877-87 FRAUD (1-877-873-7283)
or click here to file a complaint electronically.
Providers that commit Medicaid fraud, waste, or abuse may be excluded from participating in the Medicaid program. These providers cannot offer services to Medicaid enrollees or be paid with Medicaid dollars.
Prior to adding new staff members, employers should check to see if prospective employees have been excluded from Medicaid.
To check the status of any exclusion, click here.
14 November 2016
A Brooklyn pharmacist arrested in March by Federal Bureau of Investigation (FBI) agents following an OMIG-assisted investigation was convicted in federal court last week for conspiring to illegally distribute oxycodone and commit Medicaid fraud. Kia [ ... ]
04 November 2016
The NYS Attorney General's office filed felony criminal charges against a Nyack woman who allegedly submitted nearly $2 million in fraudulent substance abuse treatment service claims for reimbursement to the Medicaid program and to the state-funded M [ ... ]
The New York State Office of the Medicaid Inspector General (OMIG) has released its 2015 Annual Report, which details New York's Medicaid program integrity efforts for 2015. Results include: More than $1.8 billion in avoided costs to the Medicai [ ... ]
The New York State Office of the Medicaid Inspector General (OMIG) today posted on its website Compliance Program Review Guidance, which details what OMIG looks for when assessing compliance programs required under New York State Social Services La [ ... ]
26 October 2016
The mastermind of the counterfeit HIV drug scheme in which Medicaid was illegally billed $154 million but who was ultimately arrested as a result of the OMIG-assisted, Attorney General's Medicaid Fraud Control Unit (MFCU) investigation was sentenced [ ... ]
Providers who identify Medicaid overpayments are obligated to return those funds. All overpayments must be reported to OMIG. For more information and to complete the process, go to Self-Disclosure.
