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US Attorney Attacks AG Bonta Over Rampant California Fraud

AP Photo/Damian Dovarganes

Tuesday of this week, US Attorney for Central California Bill Essayli announced a major fraud prosecution involving a man in Orange County. Paul Richard Randall pleaded guilty to one count of wire fraud but the case itself involves more than a quarter billion dollars in fake healthcare claims which Randall submitted to Medi-Cal.

According to his plea agreement, Randall, along with Kyrollos Mekail, 37, of Moreno Valley, and Patricia Anderson, 58, of West Hills, took advantage of Medi-Cal’s suspension of 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.

Through a business called Monte Vista Pharmacy, Randall and his co-schemers 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 included Folite tablets, a vitamin available over the counter...

Randall and others then laundered their illicit proceeds by transferring the proceeds of the Medi-Cal fraud scheme to a third party to pay kickbacks to Anderson, to promote the fraud scheme and to conceal and disguise the transfers from detection by law enforcement.

Randall admitted in his plea agreement to transmitting by wire at least approximately $269,120,829 in false and fraudulent claims to Medi-Cal for purportedly dispensing the fraud scheme medications that Anderson prescribed, on which Medi-Cal paid at least approximately $178,746,556.

In a tweet about the case, US Attorney Bill Essayli criticized the state of California for failing to prevent the fraud.

California AG Rob Bonta must have felt this was directed at him because he responded by saying his office had helped investigate this particular case with the DOJ.

You may have noticed that Bonta's quote is not accurate. Essayli didn't fault California for failing to "fight fraud" he said the state failed to "prevent fraud." There is a difference and the latter point seems pretty undeniable. Just yesterday we had another story about billions in potential fraud involving the state's home health care system. It turns out that this system is employs more Californians than any other job.

“IHSS provider” has become the largest low-wage occupation statewide, with more than 800,000 taxpayer-funded caregivers offering everything from grocery shopping to personal care. 

The system operates largely on trust. Providers self-report their timecards and check-in records. In roughly 60% of cases, providers and beneficiaries live together...

According to the state’s Department of Social Services, for one 12-month period between 2023 and 2024, counties received nearly 7,000 fraud complaints; 28 counties recorded 964 fraud investigations, resulting in just 39 cases prosecuted. 

Honestly it doesn't sound like California is even fighting this fraud, much less preventing it. In any case, Essayli clarified the difference.

Having my office prosecute fraudsters to whom California blindly handed out millions does not count as “fighting fraud.”

It’s the federal government cleaning up after you and the Governor’s incompetence.

Maybe you should spend more time prosecuting your own fraudsters and filling up your prisons, and less time cooking up political lawsuits against the Trump Administration.

 Essayli went after Bonta again in another tweet.

Bonta responded to that with a handful of examples:

Those are great and if California's fraud problem numbered in the hundreds of examples, maybe that would be a solid response. But if California's fraud involves thousands of instances and tens of billions of dollars across multiple programs, it's not very impressive.

Here's Essayli making the case that California isn't doing enough to prevent fraud using the case described above as an example.

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