LOS ANGELES
The Justice Department announced Thursday that a Riverside County pharmacist is being charged for allegedly using his Montclair pharmacy to submit more than $300 million in fraudulent Medi-Cal claims.
The claims were allegedly used 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 stated.
Officials stated that Kyrollos Mekail, 36, of Moreno Valley, is charged with two counts of healthcare fraud.
The charges filed in federal court are part of the Department of Justice’s 2024 National Health Care Fraud Enforcement Action.
“This case alleges that a licensed pharmacist committed an enormous fraud against a public health program designed to help our state’s neediest residents,” said United States Attorney Martin Estrada. “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.”
“It does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a health care company, if you profit from the unlawful distribution of controlled substances, you will be held accountable,” said Attorney General Merrick B. Garland. “The Justice Department will bring to justice criminals who defraud Americans, steal from taxpayer-funded programs, and put people in danger for the sake of profits.”
According to court documents, 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.
Officials stated that Monte Vista Pharmacy is a provider under Medi-Cal, a California healthcare benefit program that reimburses low-income individuals for medically necessary healthcare services.
This includes families with children, seniors, persons with disabilities, individuals in foster care, and pregnant women—and receives a significant amount of federal funding.
In early 2022, Medi-Cal suspended 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.
From May 2022 to March 2023, Mekail and his co-schemers 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.
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 court documents, in less than one year, Monte Vista Pharmacy billed Medi-Cal approximately $306,521,392 for the medications, of which Medi-Cal paid Monte Vista Pharmacy approximately $204,032,151.
Mekail allegedly paid two co-schemers more than $36 million of the fraudulently obtained Medi-Cal proceeds as kickbacks for referring the prescriptions. He allegedly disguised these kickbacks as payments for “consulting services.”
If convicted of all charges, Mekail would face a statutory maximum sentence of 10 years in federal prison for each count of healthcare fraud. He is presumed innocent unless proven guilty.
The U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), the FBI, and the California Department of Justice are investigating this matter.
Assistant United States Attorney Roger A. Hsieh of the Major Frauds Section and Assistant Chief Niall M. O’Donnell and Trial Attorney Siobhan M. Namazi of the U.S. Department of Justice, Criminal Division, Fraud Section are prosecuting this case.