Mega Health Care Scam: Orange County Man Arraigned On $270M In Bogus Claims

ORANGE COUNTY, CA — An Orange County man is expected to be arraigned Thursday for his alleged role in a health care mega-scam 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 to the purported recipients.

Paul Randall, 66, of Orange is charged with aiding and abetting 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.

According to an affidavit filed in Los Angeles federal court, Randall, Kyrollos Mekail, 37, of Moreno Valley, and Patricia Anderson, 57, of West Hills allegedly took advantage of Medi-Cal's suspension of 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.

Through a business called Monte Vista Pharmacy, Randall and associates are alleged to have 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.

Some prescription medications purportedly were to treat pain and included folic acid tablets, a vitamin available over the counter, prosecutors said.

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, according to the DOJ.

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.

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 allege.

In a related matter, Anderson was charged in a two-count information charging her with health care fraud for her role in the scheme, which was unsealed last week. Mekail pleaded guilty to criminal charges in August 2024 and awaits sentencing.