California Man Pleads Guilty to Orchestrating $270M Medication Reimbursement Fraud Scheme

A California man pleaded guilty yesterday to submitting nearly $270 million in fraudulent claims over an 11-month span to California’s Medicaid program (Medi-Cal) for expensive prescription drugs that were medically unnecessary and, in many instances, not provided to the purported recipients. The Department of Justice announced this case and two others in support of President Trump’s Task Force to Eliminate Fraud at a press conference in Washington today. According to court documents, Paul Randall, 66, of Orange, along with pharmacist and pharmacy owner Kyrollos Mekail, 37, of Moreno Valley, and nurse practitioner Patricia Anderson, 58, of West Hills, exploited Medi-Cal’s suspension of its requirement that health care providers obtain prior authorization before providing certain medications at the beginning of 2022. Medi-Cal temporarily suspended the requirement as part of a transition to a new payment system. Using a business called Monte Vista Pharmacy, which Mekail owned, Randall and his co-schemers billed Medi-Cal tens of millions of dollars per month for purportedly dispensing high-reimbursement drugs containing cheap, generic ingredients that were manufactured in unique dosages, combinations or package quantities and were not included in the applicable maximum price lists that cap Medi-Cal reimbursements.

See Also: Justice Department Prosecutes a Half-Billion Dollars in Healthcare and COVID Fraud Schemes Exploiting Taxpayer Funded Programs

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