{"id":56857,"date":"2024-06-27T16:00:12","date_gmt":"2024-06-27T23:00:12","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=56857"},"modified":"2024-06-27T16:01:04","modified_gmt":"2024-06-27T23:01:04","slug":"pharmacist-charged-for-allegedly-submitting-over-300-million-in-fraudulent-claims-to-medi-cal","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=56857","title":{"rendered":"Pharmacist Charged for Allegedly Submitting Over $300 Million in Fraudulent Claims to Medi-Cal"},"content":{"rendered":"

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0LOS ANGELES\u00a0<\/strong><\/span><\/p>\n

\"TwoThe 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.<\/span><\/p>\n

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.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Officials stated that Kyrollos Mekail, 36, of Moreno Valley, is charged with two counts of healthcare fraud.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The charges filed in federal court are part of the Department of Justice\u2019s 2024 National Health Care Fraud\u00a0Enforcement Action<\/a>.<\/span><\/p>\n

\"white<\/a><\/p>\n

\u201cThis case alleges that a licensed pharmacist committed an enormous fraud against a public health program designed to help our state\u2019s neediest residents,\u201d said United States Attorney Martin Estrada. \u201cBringing 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.\u201d<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span>\u00a0 \u201cIt 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,\u201d said Attorney General Merrick B. Garland. \u201cThe 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.\u201d<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/span>\u00a0 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. <\/span><\/p>\n

\"coloredOfficials 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.<\/span><\/p>\n

This includes families with children, seniors, persons with disabilities, individuals in foster care, and pregnant women\u2014and receives a significant amount of federal funding.<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 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.<\/span><\/p>\n

\"\"The suspension of the prior authorization requirements was part of an ongoing transition of Medi-Cal\u2019s prescription drug program to a new payment system.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 From May 2022 to March 2023, Mekail and his co-schemers allegedly exploited Medi-Cal\u2019s 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. <\/span><\/p>\n

Some prescription medications purportedly were to treat pain and also included Folite tablets, a vitamin available over the counter.<\/span><\/p>\n

\"FBINormally, these high-cost reimbursement medications would have required prior authorization under Medi-Cal\u2019s old payment system. <\/span><\/p>\n

The information alleges the medication involved in this scheme was medically unnecessary, frequently was not dispensed to patients, and procured by kickbacks.\u00a0<\/span><\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 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.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 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 \u201cconsulting services.\u201d<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span>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.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 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.<\/span><\/p>\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Assistant United States Attorney Roger A. Hsieh of the Major Frauds Section and Assistant Chief Niall M. O\u2019Donnell and Trial Attorney Siobhan M. Namazi of the U.S. Department of Justice, Criminal Division, Fraud Section are prosecuting this case.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0LOS ANGELES\u00a0 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…<\/p>\n","protected":false},"author":1,"featured_media":16417,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-56857","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"\nPharmacist Charged for Allegedly Submitting Over $300 Million in Fraudulent Claims to Medi-Cal<\/title>\n<meta name=\"description\" content=\"\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0LOS ANGELES\u00a0 The Justice Department announced Thursday that a Riverside County pharmacist is being charged for allegedly using his Montclair\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cjnotebook.com\/?p=56857\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" 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