This must be a record: dude raked in *278 million* dollars via fraudulent Medicaid billing

quote:

---

An Orange County man and his accomplices have been busted in a $270 million Medi-Cal fraud scheme, as officials continue to crack down on abuse of taxpayer dollars in California.

Paul Richard Randall, 66, of Orange pleaded guilty to submitting the bogus claims to Medi-Cal over an 11-month span for pricey prescription drugs that contained generic ingredients that patients either didn’t need or never received, the Department of Justice announced on Monday.


The DOJ said Randall along with Kyrollos Mekail, 37, of Moreno Valley, and Patricia Anderson, 58, of West Hills, took advantage of Medi-Cal’s previous suspension of a prior authorization requirement that health care providers obtain before providing certain health care services or medications as a condition of reimbursement, per the press release.

---

quote:

---

The DOJ said that Randall along with his co-schemers, through a business called Monte Vista Pharmacies, exploited Medi-Cal’s prior authorization suspension by billing Medi-Cal tens of millions of dollars per month for dispensing high-reimbursement, non-contracted, generic drugs through Monte Vista Pharmacy.

---

quote:

---

From May 2022 to April 2023, the pharmacy 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, the release added.

The department said the three laundered the illicit money they got through the fraud scheme through a third party to pay kickbacks to Anderson, to hide what they were doing from detection.

“Schemes that bill Medicaid for costly drugs that patients never needed or received threaten the integrity of the program,” Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) said.

---