Change of plea hearing delayed for RivCo druggist in $300M Medi-Cal fraud case
A change of plea hearing was delayed today until Aug. 5 for a druggist from Riverside County accused of using his 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 obtained through the payment of illegal kickbacks.
Kyrollos Mekail, 36, of Moreno Valley, has agreed to enter his plea in downtown Los Angeles to two counts of health care fraud, according to the U.S. Department of Justice.
"This case alleges that a licensed pharmacist committed an enormous fraud against a public health program designed to help our state's neediest residents,'' U.S. Attorney Martin Estrada said in a statement when charges were announced last month. "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."
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. The 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 patients.
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 to March 2023, Mekail and his associates 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, according to the DOJ.
Normally, these high-cost reimbursement medications would have required prior authorization under Medi-Cal's old payment system. The charges allege the medication involved in the scheme was medically unnecessary, frequently was not dispensed to patients, and procured by kickbacks, federal prosecutors said.
In less than one year, Monte Vista billed Medi-Cal about $306 million for the medications, of which Medi-Cal paid the drug store over $204 million, according to documents filed in L.A. federal court.
The DOJ contends Mekail paid two co-schemers more than $36 million of the fraudulently obtained Medi-Cal proceeds as kickbacks for referring the prescriptions. He disguised these kickbacks as payments for "consulting services," the DOJ alleges.
If his plea is accepted, Mekail would face up to 10 years in federal prison for each health care fraud count, prosecutors noted.
