California Man Charged with Filing Over $300 Million in Bogus Claims to Medi-Cal

California Man Charged with Filing Over $300 Million in Bogus Claims to Medi-Cal

A pharmacy technician reaches for a bottle of medication, in this file photo. (George Frey/Getty Images)

City News Service
City News Service

6/28/2024

Updated: 6/28/2024

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LOS ANGELES—An Inland Empire pharmacist has been charged with using his Montclair pharmacy to submit more than $300 million in fraudulent Medi-Cal claims for prescription medications that were medically unnecessary, often not provided to patients and obtained through the payment of tens of millions of dollars in illegal kickbacks, officials announced Thursday.
Kyrollos Mekail, 36, of Moreno Valley, is charged with two counts of health care fraud. He is expected to be arraigned in the coming weeks in Los Angeles federal court.
“This case alleges that a licensed pharmacist committed an enormous fraud against a public health program designed to help our state’s neediest residents,” U.S. Attorney Martin Estrada said in a statement.
“Bringing to justice those who unlawfully take from the public is a priority for my office, especially where those offenders harm the most vulnerable in our community.”
According to court documents, Mr. Mekail is a licensed California pharmacist who owns, operates, and is the pharmacist-in-charge of the Montclair-based Monte VP LLC, which does business as Monte Vista Pharmacy. Monte Vista Pharmacy is a provider under Medi-Cal, a California health care benefit program that provides reimbursement for medically necessary health care services for low-income patients.
In early 2022, Medi-Cal suspended its requirement that health care providers obtain prior authorization before providing certain health care 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.
From May to March 2023, Mr. Mekail and his associates allegedly 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 also included Folite tablets, a vitamin available over the counter, according to the U.S. Department of Justice.
Normally, these high-cost reimbursement medications would have required prior authorization under Medi-Cal’s old payment system. The information alleges the medication involved in this scheme was medically unnecessary, frequently was not dispensed to patients, and procured by kickbacks, according to the DOJ.
In less than one year, Monte Vista Pharmacy billed Medi-Cal about $306 million for the medications, of which Medi-Cal paid Monte Vista Pharmacy over $204 million, according to court documents.
Mr. Mekail allegedly paid two co-schemers more than $36 million of the fraudulently obtained Medi-Cal proceeds as kickbacks for referring the prescriptions. He disguised these kickbacks as payments for “consulting services,” federal prosecutors contend.
If convicted of all charges, Mr. Mekail would face up to 10 years in federal prison for each health care fraud count, prosecutors noted.
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