OC man charged for alleged role in $270 million Medi-Cal medication reimbursement scheme
OC man charged for alleged role in $270 million Medi-Cal medication reimbursement scheme
An Orange County man has been charged with helping carry out a nearly $270 million Medi-Cal fraudulent billing scheme that prosecutors allege took advantage of changes to the health care program’s medication reimbursement policies.
Paul Richard Randall, 66, of Orange is facing a federal charge of aiding and abetting a health care fraud, the U.S. Attorney’s Office announced on Monday, June 30.
Federal prosecutors allege that over an 11 month period, Randall — along with Kyrollos Mekail of Moreno Valley and Patricia Anderson of West Hills — submitted claims to Medi-Cal through a business called Monte Vista Pharmacy for expensive prescription drugs that were not medically necessary, in many cases were not dispensed to patients and were procured by kickbacks.
Randall and the others are accused of exploiting a suspension of Medi-Cal authorization requirements that was instituted as part of a transition to a new payment system for the health care program.
Normally, prosecutors said, requests for high-cost medications would have required prior authorization in order for Monte Vista Pharmacy to be reimbursed. By “exploiting” the prior authorization suspension, prosecutors added, Randall and the others are accused of wrongly billing Medi-Cal tens of millions of dollars per month for the prescription drugs.
Monte Vista from May 2022 to April 2023 allegedly billed Medi-Cal for more than $269 million and was paid more than $178 million for what prosecutors described as “expensive, non-contracted drugs containing low-cost, generic ingredients.” Prosecutors allege that Randall and the others laundered the proceeds in order to hide the money from law enforcement.
The allegations against Randall are part of a countrywide “National Health Care Fraud Takedown” announced by the Justice Department act included more than 300 defendants across the United States.
“Public health programs are designed to help the sick and needy, not to help unscrupulous individuals pad their pockets,” United States Attorney Bill Essayli said in a written statement. “Working with our federal and state law enforcement partners, we will continue to crack down on those who cheat taxpayers via health care fraud.”
The U.S. Attorney’s Office also confirmed that Randall is the same healthcare marketer and former medical group owner who in 2012 pleaded guilty to his role in a $600 million spinal surgery kickback scheme.
Randall is currently being held without bond, prosecutors said. It was not immediately known if he had an attorney who could comment on the allegations.
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