An Inland Empire pharmacist accused of submitting more than $300 million in fraudulent Medi-Cal claims for prescriptions processed through his pharmacy was charged with health care fraud on Thursday, June 27, by the Justice Department.
Officials accuse Kyrollos Mekail, 36, of Moreno Valley, of prescribing medications that were “medically unnecessary and often not provided to patients and were obtained through payment of tens of millions of dollars in illegal kickbacks,” officials with the department said in a statement.
Mekail, who operated the Monte Vista Pharmacy in Montclair, is expected to be arraigned in the United States District Court in coming weeks.
If convicted, he could face 10 years in federal prison for each of the two counts against him, officials said. Officials from the U.S. Department of Health and Human Services Office of Inspector General, the FBI, and the California Department of Justice are investigating the case.
“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. “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 the investigation, court documents show that Mekail is a licensed pharmacist and that his pharmacy receives significant federal reimbursement for providing Medi-Cal to low-income people, seniors and the disabled.
Federal officials said that Mekail and those “he schemed with ” 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 the pharmacy from March 2022 until March 2023.
Some prescriptions put through Medi-Cal were painkillers, and some, like Folite tablets, were over-the-counter vitamins, officials said.
Under Medi-Cal’s old payment system, the medications dispensed would have required prior authorization. The information alleges that the medication involved in this scheme was medically unnecessary, frequently not dispensed to patients, and procured by kickbacks, officials said.
In less than a year, the pharmacy billed Medi-Cal more than $306 million for the medications, of which Medi-Cal then paid Monte Vista Pharmacy more than $204 million, according to court documents federal officials said on Thursday.
Mekail allegedly paid two co-schemers more than $36 million of the fraudulently obtained Medi-Cal proceeds as kickbacks for referring the prescriptions, investigators found. He allegedly disguised these kickbacks as payments for “consulting services.”
“Health care fraud affects every American,” Nicole M. Argentieri, principal deputy assistant attorney general and head of the Justice Department’s criminal division, said. “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.”