SAN FRANCISCO (CBS SF) — Four defendants have pleaded guilty to a variety of federal racketeering charges involving diversion of prescription drugs, money laundering, bank fraud and identity theft in connection to a nationwide crime operation, according to federal prosecutors.

In a joint statement, U.S. Attorney David L. Anderson; FBI Special Agent in Charge John F. Bennett and IRS officials announced that Mihran Stepanyan, Artur Stepanyan, Yan German and Khachig Geuydjian entered guilty pleas in San Francisco on Wednesday.

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The pleas left remaining defendant to stand trial for allegations stemming from a major federal crackdown of the nationwide Karapedyan-Stepanyan Enterprise crime operation.

Among the crimes was the distribution of millions in black market pharmaceuticals to unsuspecting patients.

“Patients needing prescription drugs shouldn’t have to worry that their medications came out of a back alley,” said Anderson in a news release. “The defendants and their co-conspirators were able to make massive profits by diverting street drugs back into mainstream channels while creating false paperwork to conceal their true source.”

According to the plea agreements, members and associates of the Enterprise procured prescription drugs from unlicensed sources, usually street dealers, and resold the drugs to unknowing customers. The drugs included medications used to treat HIV infection, Type-2 diabetes, dementia, and high blood pressure, among other conditions.

In total, more than $199 million in diverted prescription drug proceeds were laundered through bank accounts established with false identities and shell companies.

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“The American public was victimized twice by this scheme,” Bennett said. “The majority of the profits were subsidized both by American taxpayers and by those paying private insurance premiums. Additionally, patients were put at risk by the movement of these black market drugs, as the defendants disregarded general safety protocols and guidelines, to include expiration dates and pharmaceutical lot numbers.”

Federal prosecutors said members of the Enterprise conducted the affairs of the organization through a pattern of racketeering and committed crimes throughout California as well as in Minnesota, Ohio, and Puerto Rico.

In his plea agreement, Mihran Stepanyan also admitted purchasing approximately $56 million in gold using the illicit proceeds from the unlawful sale of prescription drugs.

German admitted in his plea agreement that between 2013 and 2014, he obtained boxes full of prescription drugs from one of his co-conspirators in Los Angeles. He would pick up drugs from one of his sources at a pizza shop with the help of one of his associates, load the boxes into the trunk of a car and drive them to a nearby mall or another pre-arranged location where he would deliver them to the Stepanyans.

The plea agreement also describes how Geuydjian’s co-conspirators acquired and possessed stolen identifying information for dozens of individuals in order to file fraudulent tax returns online.

The Enterprise obtained checks issued by the federal government and mailed from the United States Treasury. From approximately August 2012 through August 2013, Geuydjian fraudulently liquidated approximately 51 checks totaling more than $538,295 though accounts he held in the names of three companies he controlled.

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In addition to the Stepanyans, Geuydjian and German, more than 20 other members and associates of the Enterprise have pleaded guilty to a laundry list of federal charges.