LOS ANGELES \u2013 An Orange County man is expected to plead guilty Wednesday for his alleged role in a health-care fraud scheme in which nearly $270 million in bogus claims were submitted to Medi-Cal for expensive prescription drugs that were not medically necessary and, in many instances, not provided.<\/p>\n
Paul Randall, 66, of Orange, has agreed to enter a plea in downtown Los Angeles to a single count of health care fraud, a felony carrying a possible penalty of up to 10 years in federal prison, according to the U.S. Department of Justice.<\/p>\n
Randall was originally set to plead guilty Monday, but that hearing was postponed due to the \u201cunavailability\u201d of the defendant, court records show.<\/p>\n
An affidavit filed in Los Angeles federal court alleges that Randall, Kyrollos Mekail, 37, of Moreno Valley, and Patricia Anderson, 58, of West Hills took advantage of Medi-Cal\u2019s suspension of its requirement that caregivers obtain prior authorization before providing certain services or medications as a condition of reimbursement.<\/p>\n
The suspension of the requirement was part of the transition of Medi- Cal\u2019s prescription drug program to a new payment system.<\/p>\n
Through a business called Monte Vista Pharmacy, Randall and associates are alleged to have exploited Medi-Cal\u2019s prior authorization suspension by billing Medi-Cal tens of millions of dollars per month for dispensing high- reimbursement, non-contracted, generic drugs.<\/p>\n
Some prescription medications purportedly were to treat pain and included Folite tablets, a vitamin available over the counter, prosecutors said.<\/p>\n
Normally, high-cost reimbursement medications would have required prior authorization under Medi-Cal\u2019s old payment system. Medication involved in this scheme was medically unnecessary, frequently was not dispensed to patients, and was procured by kickbacks, according to the DOJ.<\/p>\n
From May 2022 to April 2023, Monte Vista billed Medi-Cal more than $269 million and was paid more than $178 million for 19 expensive, non- contracted drugs containing low-cost, generic ingredients that were not medically necessary, not provided, or both, court papers show.<\/p>\n
Randall and others then laundered their illicit proceeds by transferring the proceeds of the Medi-Cal fraud scheme to a third party to pay kickbacks to Anderson, to promote the fraud scheme and to conceal and disguise the transfers from detection by law enforcement, federal prosecutors contend.<\/p>\n
Anderson was charged last year with health care fraud for her role in the scheme. Mekail pleaded guilty to criminal charges in August 2024 and awaits sentencing.<\/p>\n
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