Husband and Wife Charged with Health Care Fraud
John H. Durham, United States Attorney for the District of Connecticut, and Patricia M. Ferrick, Special Agent in Charge of the New Haven Division of the Federal Bureau of Investigation, today announced that a federal grand jury in New Haven returned a 17-count indictment yesterday charging KWASI GYAMBIBI, 40, of Stamford, and KAKRA GYAMBIBI, 37, formerly of New Canaan and currently residing in Maryland, with health care fraud offenses.
KWASI GYAMBIBI was arrested this morning in Stamford. He was arraigned before U.S. Magistrate Judge Sarah A. L. Merriam in New Haven, entered not guilty pleas to the charges, and was released on bond. KAKRA GYAMBIBI is expected to appear in federal court to answer the charges by July 2, 2018.
As alleged in the indictment, KWASI GYAMBIBI and KAKRA GYAMBIBI are married. KWASI GYAMBIBI was formerly employed by the State of Connecticut and worked at UConn-Stamford, and KAKRA GYAMBIBI is a physician who worked as a hospitalist at Stamford Hospital. Advantage Pharmacy was a compounding pharmacy located in Hattiesburg, Mississippi. As a compounding pharmacy, Advantage created compound prescription drugs specifically tailored for individual patients who had a medical need for a compound drug, by mixing together individual ingredients in the exact strength and dosage prescribed by the health care provider to meet the unique needs of a patient. One tube of a compound drug cream prepared and dispensed by Advantage Pharmacy typically cost health care benefit programs thousands of dollars, and some individual tubes of cream cost more than $10,000 for a one-month supply. KWASI GYAMBIBI acted as, and eventually became, a sales representative for Advantage Pharmacy.
The indictment alleges that, in 2014 and 2015, KWASI and KAKRA GYAMBIBI engaged in a scheme to defraud the State of Connecticut Pharmacy Benefit Plan, TRICARE and other health care programs by submitting prescriptions for compound pharmacy medications prepared and dispensed by Advantage Pharmacy. Although the prescriptions were signed by KAKRA GYAMBIBI, she did not treat, examine, or even meet with the patients for whom the prescriptions were written. Based on these false and misleading claims, the victim health care programs paid Advantage Pharmacy for the compound prescription drugs. Advantage Pharmacy, in tum, paid commissions of between 15 percent to 25 percent to sales representatives, including KWASI GYAMBIBI’s cousin.
The indictment further alleges that KWASI GYAMBIBI and KAKRA GYAMBIBI also induced the victim health care programs to pay Advantage Pharmacy more than $280,000 for their own compound prescription drugs.
It is alleged that the scheme resulted in more than $1.5 million in losses to the victim health care programs.
The indictment charges each defendant with 16 counts of health care fraud and one count of conspiracy to commit health care fraud. Each of the counts carries a maximum term of imprisonment of 10 years.
U.S. Attorney Durham stressed that an indictment is not evidence of guilt. Charges are only allegations and a defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt.
This investigation is being conducted by the Federal Bureau Investigation. U.S. Attorney Durham thanked the Office of the Attorney General of the State of Connecticut for their assistance with the investigation. The case is being prosecuted by Assistant U.S. Attorney David J. Sheldon.
This indictment is announced as part of a national health care fraud takedown. Earlier today, Attorney General Jeff Sessions and other federal law enforcement officials announced the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, The U.S. Department of Health and Human Services announced that, since July 2017, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”