Houston man guilty in $160M Medicare fraud scheme

Date: Oct. 15, 2024

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HOUSTON - A Houston man has been convicted of all 15 counts as charged for heading a massive Medicare fraud scheme involving the fraudulent billing of expensive topical creams, announced U.S. Attorney Alamdar S. Hamdani.

The jury deliberated for less than five hours before convicting Mohamad Mokbel following a 10-day trial.

From 2014 through 2021, Mohamad Mokbel led a company called 4M Pharmaceuticals which operated 14 pharmacies with straw owners. The jury heard evidence that Mokbel illegally purchased thousands of Medicare beneficiaries, including their identification number, personal health and physician information. Mokbel targeted elderly diabetic patients who are dependent on diabetic testing supplies to manage their blood sugar levels. Mokbel paid $16 to $40 per Medicare beneficiary.

To maximize reimbursements and without regard for medical necessity, Mokbel then directed 4M employees to use the Medicare beneficiaries' patient data to run insurance claims to determine if Medicare or other insurance plans would cover and reimburse at a high rate for the topical creams, Omega-3 pills and other medications that Mokbel intended to sell through 4M pharmacies.

At Mokbel's direction, 4M employees would then fax pre-filled prescription requests to the patients' doctors appearing to be for diabetic testing supplies with topical creams added at the bottom. They also included false representations that the patient was requesting a 4M Pharmacy fill their medications. In reality, Mokbel had previously purchased the patient's personal information, the patient had not selected a 4M Pharmacy and the patient was often unaware the request was being made on their behalf.

Many doctors apparently took the representations in the fax at face value and did sign and send back the prefilled prescription requests to 4M. Mokbel's call center in Houston and later in Egypt then contacted the patients and made false and misleading statements about the topical cream and their doctor's order. Mokbel's pharmacies then shipped out numerous topical creams, often on auto-refill, and excessively billed Medicare, Medicaid and private insurance plans.

Mokbel made over $200 million as a result of the scheme.

From 2015 through 2020, Mokbel also corruptly gave a series of bribe payments, ranging from $2,000 to $5,000 and totaling over $188,000 an employee of a pharmacy benefits manager - OptumRx - in exchange for favorable treatment for 4M pharmacies. They were credentialed and recredentialed with OptumRx which allowed them to enter into retail network agreements with OptumRx, participate in the Medicare Part D program and submit claims for prescriptions for Medicare beneficiaries. Mokbel also received information and advice about responding to audits and preventing and/or delaying OptumRX termination of many 4M pharmacies.

U.S. District Judge Lee H. Rosenthal accepted the verdict and set sentencing for Jan. 7, 2025. At that time, Mokbel faces up to 20 years for conspiracy to commit mail fraud and health care fraud, 10 years for each of five counts of health care fraud, each of six counts of money laundering and one count of bribery concerning programs receiving federal funds as well as five years for

conspiracy to violate the Anti-Kickback Statute and conspiracy to commit bribery. He could also be ordered to pay up to a total of $4 million in fines and possible restitution in excess of $160 million.

Previously released on bond, Mokbel was taken into custody pending sentencing.

The IRS Criminal Investigation (IRS-CI), FBI, Homeland Security Investigations, Department of Health and Human Services, Food and Drug Administration and the Texas Attorney General Medicaid Fraud Control Unit conducted the investigation. Assistant U.S. Attorneys Kathryn Leigh Olson and Adam Laurence Goldman are prosecuting the case.

IRS-CI is the criminal investigative arm of the IRS, responsible for conducting financial crime investigations, including tax fraud, narcotics trafficking, money-laundering, public corruption, healthcare fraud, identity theft and more. IRS-CI special agents are the only federal law enforcement agents with investigative jurisdiction over violations of the Internal Revenue Code, obtaining a more than a 90 percent federal conviction rate. The agency has 20 field offices located across the U.S. and 12 attaché posts abroad.

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