Mohamed Mokbel, 57, and Fathy Elsafty, 63, both of Houston, are expected to make their initial appearances before U.S. Magistrate Judge Yvonne Ho today at 2 p.m.

The 18-count superseding indictment, returned July 20, alleges that from 2013 to January 2022, Mokbel and ElSafty conspired to commit a $150 million mail fraud and health care fraud scheme and engaged in money laundering with the fraud proceeds. Mokbel is also alleged to have continued the fraud scheme at MK Pharmacy, a Houston area pharmacy, from April 2021 through January 2022. During this time, he had been permitted release on bond after the return of the original indictment in March 2021.

Mokbel was the CEO of 4M Pharmaceuticals Inc., according to the charges. With ElSafty’s assistance, he allegedly acquired and controlled over a dozen pharmacies that operated in Houston and elsewhere. The indictment alleges Elsafty served as 4M’s accountant and tax preparer and had ownership interests in several pharmacies located in California, Texas and Florida. ElSafty allegedly aided Mokbel by falsifying corporate filings and concealing Mokbel’s involvement in the pharmacies.

The fraud was pervasive and carried out using a sophisticated mass marketing scheme targeting individuals over the age of 55 using telemarketing and mail, according to the charges. Mokbel is alleged to have purchased patient data and directed 4M Pharmaceuticals’ employees to submit test claims to patient insurance plans to determine insurance coverage.

4M then allegedly sent prescription fax requests to doctors’ offices on behalf of the patients without their knowledge or consent. In some cases, 4M requested prescriptions for patients who had been dead for months, if not years, according to the allegations.

Company employees then allegedly called patients to report their doctor had approved prescriptions for them and that they would receive the medications at no cost. However, Medicare and other insurance plans often required a copay which 4M did not collect, according to the charges. When audited, 4M allegedly falsified proof of the copay collection.

Mokbel and ElSafty are charged with one count of a conspiracy to commit mail and health care fraud, two counts of health care fraud and 15 counts of money laundering.

If convicted of the conspiracy, they face up to 20 years in prison, while the health care violations carry a 10-year-term. Money laundering also carries a potential 10-year sentence. The use of telemarketing to target people over 55 as a means to commit mail fraud and health care fraud carries an additional penalty of 10 years. Fines could also be assessed in the amounts of $250,000 or not more than twice the amount of the criminally derived property involved in the transaction.

Mohamed Mokbel, 57, and Fathy Elsafty, 63, both of Houston, are expected to make their initial appearances before U.S. Magistrate Judge Yvonne Ho today at 2 p.m.

The 18-count superseding indictment, returned July 20, alleges that from 2013 to January 2022, Mokbel and ElSafty conspired to commit a $150 million mail fraud and health care fraud scheme and engaged in money laundering with the fraud proceeds. Mokbel is also alleged to have continued the fraud scheme at MK Pharmacy, a Houston area pharmacy, from April 2021 through January 2022. During this time, he had been permitted release on bond after the return of the original indictment in March 2021.

Mokbel was the CEO of 4M Pharmaceuticals Inc., according to the charges. With ElSafty’s assistance, he allegedly acquired and controlled over a dozen pharmacies that operated in Houston and elsewhere. The indictment alleges Elsafty served as 4M’s accountant and tax preparer and had ownership interests in several pharmacies located in California, Texas and Florida. ElSafty allegedly aided Mokbel by falsifying corporate filings and concealing Mokbel’s involvement in the pharmacies.

The fraud was pervasive and carried out using a sophisticated mass marketing scheme targeting individuals over the age of 55 using telemarketing and mail, according to the charges. Mokbel is alleged to have purchased patient data and directed 4M Pharmaceuticals’ employees to submit test claims to patient insurance plans to determine insurance coverage.

4M then allegedly sent prescription fax requests to doctors’ offices on behalf of the patients without their knowledge or consent. In some cases, 4M requested prescriptions for patients who had been dead for months, if not years, according to the allegations.

Company employees then allegedly called patients to report their doctor had approved prescriptions for them and that they would receive the medications at no cost. However, Medicare and other insurance plans often required a copay which 4M did not collect, according to the charges. When audited, 4M allegedly falsified proof of the copay collection.

Mokbel and ElSafty are charged with one count of a conspiracy to commit mail and health care fraud, two counts of health care fraud and 15 counts of money laundering.

If convicted of the conspiracy, they face up to 20 years in prison, while the health care violations carry a 10-year-term. Money laundering also carries a potential 10-year sentence. The use of telemarketing to target people over 55 as a means to commit mail fraud and health care fraud carries an additional penalty of 10 years. Fines could also be assessed in the amounts of $250,000 or not more than twice the amount of the criminally derived property involved in the transaction.

Mohamed Mokbel, 57, and Fathy Elsafty, 63, both of Houston, are expected to make their initial appearances before U.S. Magistrate Judge Yvonne Ho today at 2 p.m.

The 18-count superseding indictment, returned July 20, alleges that from 2013 to January 2022, Mokbel and ElSafty conspired to commit a $150 million mail fraud and health care fraud scheme and engaged in money laundering with the fraud proceeds. Mokbel is also alleged to have continued the fraud scheme at MK Pharmacy, a Houston area pharmacy, from April 2021 through January 2022. During this time, he had been permitted release on bond after the return of the original indictment in March 2021.

Mokbel was the CEO of 4M Pharmaceuticals Inc., according to the charges. With ElSafty’s assistance, he allegedly acquired and controlled over a dozen pharmacies that operated in Houston and elsewhere. The indictment alleges Elsafty served as 4M’s accountant and tax preparer and had ownership interests in several pharmacies located in California, Texas and Florida. ElSafty allegedly aided Mokbel by falsifying corporate filings and concealing Mokbel’s involvement in the pharmacies.

The fraud was pervasive and carried out using a sophisticated mass marketing scheme targeting individuals over the age of 55 using telemarketing and mail, according to the charges. Mokbel is alleged to have purchased patient data and directed 4M Pharmaceuticals’ employees to submit test claims to patient insurance plans to determine insurance coverage.

4M then allegedly sent prescription fax requests to doctors’ offices on behalf of the patients without their knowledge or consent. In some cases, 4M requested prescriptions for patients who had been dead for months, if not years, according to the allegations.

Company employees then allegedly called patients to report their doctor had approved prescriptions for them and that they would receive the medications at no cost. However, Medicare and other insurance plans often required a copay which 4M did not collect, according to the charges. When audited, 4M allegedly falsified proof of the copay collection.

Mokbel and ElSafty are charged with one count of a conspiracy to commit mail and health care fraud, two counts of health care fraud and 15 counts of money laundering.

If convicted of the conspiracy, they face up to 20 years in prison, while the health care violations carry a 10-year-term. Money laundering also carries a potential 10-year sentence. The use of telemarketing to target people over 55 as a means to commit mail fraud and health care fraud carries an additional penalty of 10 years. Fines could also be assessed in the amounts of $250,000 or not more than twice the amount of the criminally derived property involved in the transaction.

• On February 15, 2011, her license had been revoked by the Board of Pharmacy.
• At the November 2011 Board meeting, she sought reinstatement of her license.
• On January 9, 2012 the Board reinstated her license, with conditions, and with a probationary status.
• April 8, 2020 and lasting until or about May 7, 2020, she diverted approximately 150 tablets and capsules of oxycodone and Vyvanse.
• On January 20, 2021, she signed a Consent Order with the Board of Pharmacy agreeing to these stipulations of facts and voluntarily surrendering her license.

“She was a nurse at UnityPoint, was fired, then she’s up working again at Manchester, doing it all over again,” Vavricek said. “I’m not sure how that’s allowed in the state of Iowa … but she kept being a predator on these poor, elderly people who are dying and in pain.”

According to court records, Boll was fired from one Iowa hospital due to irregularities with narcotics handling, was quickly hired at a larger hospital where she was later suspended and then fired for narcotics handling, and then wound up working at a nursing home where she was fired for the same offense.

At all three health care institutions, Boll later admitted, she repeatedly stole drugs intended to ease the suffering of patients.

“She is a danger to the community,” Vavricek told the judge. “She — on at least 50 occasions — admits she stole hydrocodone from patients of a nursing home over a four-month period … And these elderly hospice patients died, and they died in pain at her hands.”

So how does a nurse fired for mishandling narcotics at one institution wind up working at another and then another?

An Iowa Capital Dispatch review of state and federal records shows that the safety net intended to protect patients from criminal caregivers is riddled with holes. Health facilities don’t share information about past employees’ misconduct; licensing boards don’t tell the public about criminal convictions of the professionals they oversee; and state inspectors don’t always sanction the facilities where the crimes are committed.

From October 2016 to August 2017, Boll worked at Manchester’s Regional Medical Center as a nurse. According to court records, she was fired from the hospital for a variety of issues, including inaccurate documentation of narcotics handling. Later, she admitted that while working at the hospital she regularly signed out medications, claiming to have given them to patients, but she was instead pocketing the drugs for her own use. She also admitted stealing injectable narcotics from hospice patients at the medical center.

Within three weeks of being fired from the Manchester hospital, Boll went to work as a nurse at Unity Point-St. Luke’s Hospital in Cedar Rapids. During her time there, she later admitted, she stole narcotic pain medication from hospice patients on numerous occasions. She was fired after an internal investigation found that she failed to follow the protocol for administering pain medications and failed to properly discard excess controlled substances. She had previously been suspended and warned about her failure to follow pain management protocols.

Almost immediately, Boll landed a job at the Good Neighbor nursing home in Manchester. She later admitted that on at least 50 occasions, she took hydrocodone prescribed for residents of the home. She said she stole the drugs by replacing them with over-the-counter pills such as Tylenol.

She also admitted that on Christmas Eve, 2018, she took the liquid morphine that was set up to provide 92-year-old Alice Bandy with pain relief. Using a syringe, she extracted the morphine from the bottle and then, to hide the theft, she replaced the pain killer with mouthwash.

“I knew my mom was in pain,” says Bandy’s daughter, Joyce Becker of Dundee. “So I kept asking the nurses, ‘Can you give her something for the pain?’ And they said, ‘She’s already on morphine.’ Well, then we later came to find out she wasn’t getting any of it. It was quite a shock. Mom really trusted everyone out there.”

Bandy died two weeks after the theft, on Jan. 8, 2019. She had chosen the Good Neighbor Home when she became ill because she had worked there for 16 years as a housekeeping supervisor and had faith in the quality of care at the home.

Boll also admitted stealing morphine from another resident of the home — a 98-year-old World War II veteran who spent 20 years of his retirement delivering Meals on Wheels for his elderly, Linn County neighbors.

During one shift, on Dec. 29, Boll went into the home’s pain-medication room and stole drugs belonging to 10 different patients, replacing them with over-the-counter medications. The patients or their insurers were billed at least $593 for the drugs they never received, according to court records.

In all, 14 residents of the Good Neighbor Home were harmed by Boll. The oldest was 101 years old, but most were in their 80s and 90s, and each was suffering either from significant end-of-life complications or had dementia.

Last July, federal prosecutors charged Boll with one count of tampering with a consumer product and 16 counts of acquiring controlled substances by misrepresentation, fraud, deception and subterfuge.

As part of a plea bargain with prosecutors, Boll agreed last summer to relinquish her nursing license and prosecutors dropped 15 of the 17 charges against her. She was sentenced to four years in prison.
Boll wasn’t criminally charged or subjected to any professional discipline until after her conduct at the Good Neighbor home was uncovered. So, prior to that, any background checks and calls to the state licensing board would have turned up nothing.

But had the Regional Medical Center or UnityPoint shared information about Boll’s job performance, she might never have had the opportunity to, in the prosecutor’s words, “prey” on the residents of the Good Neighbor home.

A spokeswoman for Regional Medical Center did not respond to several calls and emails from the Iowa Capital Dispatch, so it’s not clear what the hospital told UnityPoint and Good Neighbor.

However, both UnityPoint and Good Neighbor say they do not share with other employers negative information about past employees’ conduct.
When asked what prevents UnityPoint from sharing that sort of information with other medical providers, hospital spokeswoman Sarah Carizzo cited a self-imposed policy — one she described as “standard operating procedure” — that limits disclosure to a worker’s dates of employment, job title and full-time or part-time status.

Good Neighbor’s administrator, Matt Carpenter, said state law prohibits the home from telling other employers about past employees’ bad acts.

But Iowa law doesn’t bar that sort of disclosure. In fact, it encourages employers to share negative information about past employees by providing them with civil immunity. They can’t be sued for relaying negative information about past employees to prospective future employers, as long as the information is shared in good faith.

Iowa’s law, however, doesn’t take the additional step of requiring disclosure, which means employers face no repercussions for establishing policies that limit disclosure to dates of employment and job titles.
UnityPoint officials point out that Boll’s nursing license was in good standing when the hospital hired her. But that doesn’t always mean a licensee has an unblemished record.

Boll’s crimes at the Good Neighbor home involved at least 14 residents and more than 50 instances of theft. But the publicly available inspection reports for the home give no indication any of that ever happened. The reports make no mention of any thefts or tampering with medication.

On March 5, the Iowa Capital Dispatch asked Iowa Department of Inspections and Appeals spokeswoman Stefanie Bond why that is. As of March 16, Bond still had no answer to the question.

It’s possible the inspections department was unaware of the thefts, or that it concluded the crimes didn’t entail any failings by the home itself with regard to quality of care or staff supervision.

The Good Neighbor home isn’t even mentioned in the Board of Nursing’s public statement of charges against Boll. The document says only that Boll was employed at “a long-term care facility” and that on “more than one occasion” she stole medication from more than one resident.

• formation of a multi-disciplinary Controlled Substance Oversight Committee, which has developed a system-wide drug diversion policy that replaced all subsidiary-specific and legacy policies;
• mandatory training for approximately 10,000 employees who have regular access to controlled substances;
• creation of hospital-based teams and task forces to monitor compliance with relevant drug protocols, investigate possible diversion and provide ongoing education and training;
• retention of an outside pharmacy management company to manage and operate its inpatient pharmacies; and
• ongoing early detection measures (both electronic and "hands on" measures) to ensure discovery of possible diversion activities.

31 doctors, seven pharmacists, eight nurse practitioners and seven others who are owners, operators or clinic employees from Ohio, Kentucky, Tennessee, West Virginia, Louisiana, Pennsylvania and Alabama are involved in the bust, which officials said is the largest crackdown of its kind in United States history.

While speaking to media on Wednesday, members of the Appalachian Regional Prescription Strike Force said those involved handed out around 350,000 prescriptions, totaling more than 32 million pills.

A doctor with Bluegrass Pain Consultants in Louisville has been named in the conspiracy. He’s accused of taking bribes and kickbacks from Assured RX, LLC, a pharmaceutical company in Florida. Assured RX, headed by a pharmacist, produced compounded drug products that were prescribed by the doctor and other medical professionals at BPC, according to the doctor's indictment.

Specifically, BPC prescribed compounded creams for scars, pain and other ailments.

Bluegrass Pain Consultants was established by the doctor  in April 2008, however the conspiracy with Assured RX didn’t begin until November 2014, according to the indictment.

Prosecutors believe the doctor accepted payments from Assured RX in exchange for prescribing compounded drugs to patients, many of whom were on Medicare and Tricare. Assured RX would then submit the claims, resulting in reimbursement.

The indictment says the conspiracy caused Tricare to pay Assured RX $41,611.35 for compounded drug products between November 2014 and July 2015. During that time, the indictment claims the pharmacist, on behalf of Assured RX, paid nearly $226,000 in bribes and kickbacks.