Three individuals have been charged with orchestrating a nearly $270 million Medi-Cal fraudulent billing scheme. The suspects submitted claims for unnecessary prescription drugs to Medi-Cal through Monte Vista Pharmacy. They exploited a suspension of reimbursement authorization requirements during a transition to a new payment system. It is alleged that Monte Vista billed Medi-Cal over $269 million from May 2022 to April 2023, receiving over $178 million for these claims. The defendants are also accused of laundering the proceeds to conceal the money from law enforcement. This case is part of a larger national health care fraud crackdown that involved over 300 defendants.
An Orange County man and two other suspects have been charged with carrying out a nearly $270 million Medi-Cal fraudulent billing scheme that prosecutors allege took advantage of changes to the health care program's medication reimbursement policies.
Randall and the others are accused of exploiting a suspension of Medi-Cal authorization requirements that was instituted as part of a transition to a new payment system for the health care program.
Monte Vista from May 2022 to April 2023 allegedly billed Medi-Cal for more than $269 million and was paid more than $178 million for what prosecutors described as expensive, non-contracted drugs containing low-cost, generic ingredients.
The allegations against Randall are part of a countrywide National Health Care Fraud Takedown announced by the Justice Department act included more than 300 defendants across the United States.
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