Montclair Pharmacist Charged with Submitting Over $300 Million in Fraudulent Claims to Medi-Cal in Medication Reimbursement Scam

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 were obtained through the payment of tens of millions of dollars in illegal kickbacks, the Justice Department announced today.

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 United States District Court.

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."

"Healthcare fraud victimizes patients, endangers the health of vulnerable people, and plunders healthcare programs," said FBI Director Christopher Wray. "This wide-ranging collaboration demonstrates the FBI's commitment to rooting out predatory healthcare fraud, protecting patients, and ensuring critical healthcare funds go where they are needed most."

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. 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 individuals - including 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 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 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.

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, according to court documents.

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."

"Health care fraud affects every American," said Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department's Criminal Division. "It siphons off hard-earned tax dollars meant to provide care for the vulnerable and disabled. In doing so, it also raises the cost of care for all patients. Even worse, as the prosecutions we announce today underscore, health care fraud can harm patients and fuel addiction. The Criminal Division is committed to rooting out health care fraud, wherever it may be found, no matter who commits it. And we are using more tools than ever before to uncover misconduct and hold wrongdoers to account, whether they are executives in corner offices or doctors who violate their oaths."

"This work is important to the Department of Health and Human Services (HHS) and the millions of Americans we serve. HHS vigorously pursues anyone who commits fraud against our health care programs. But it takes all of us, working together, to be successful," said HHS Deputy Secretary Andrea Palm. "Those who steal from these programs are stealing from the American families who rely on them and putting patients at risk. We won't stop until all those who try to defraud the federal government are caught and held accountable."

"We will not tolerate fraud that preys on patients who need and deserve high quality health care," said the HHS-OIG Inspector General Christi A. Grimm. "The hard work of the HHS-OIG team and our outstanding law enforcement partners makes today's action possible. We must protect taxpayer dollars and keep Americans safe from harms to their health, privacy, and financial well-being."

An information is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

If convicted of all charges, Mekail would face a statutory maximum sentence of 10 years in federal prison for each count of health care fraud.

The United States 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. Assistant United States Attorney James E. Dochterman of the Asset Forfeiture and Recovery Section is handling asset forfeiture matters in this case.

Public link

Please use the above public link if you want to share this noodl on another website.