An Orange County man has been charged via federal criminal complaint with submitting over an 11-month span nearly $270 million in fraudulent claims to Medi-Cal for expensive prescription drugs containing generic ingredients that were not medically necessary and, in many instances, not provided to the purported recipients. Paul Richard Randall, 66, of Orange, is charged with aiding and abetting healthcare fraud, a felony that carries a statutory maximum penalty of 10 years in federal prison. According to an affidavit filed with the complaint, Randall, Kyrollos Mekail, 37, and Patricia Anderson, 57, took advantage of Medi-Cal’s suspension of its requirement that healthcare providers obtain prior authorization before providing certain healthcare services or medications as a condition of reimbursement. The suspension of the prior authorization requirements was part of an ongoing transition of Medi-Cal’s prescription drug program to a new payment system.
Through a business called Monte Vista Pharmacy, Randall and his co-schemers 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. Some prescription medications purportedly were to treat pain and included Folite tablets, a vitamin available over the counter. Normally, these high-cost reimbursement medications would have required prior authorization under Medi-Cal’s old payment system. Medication involved in this scheme was medically unnecessary, frequently was not dispensed to patients, and procured by kickbacks. 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.