Justice Department Prosecutes Half-Billion Dollars in Healthcare and COVID Fraud Schemes

The Department of Justice announced prosecutions totaling approximately $500 million in healthcare and COVID-19 fraud across three major cases. AP of South Florida, LLC pleaded guilty to fraudulently enrolling vulnerable individuals into ACA plans, generating $141.5 million in unwarranted subsidies by falsifying income information, while parent company AssuredPartners, Inc. agreed to pay $107 million to settle related allegations. In California, Paul Randall pleaded guilty to submitting nearly $270 million in fraudulent Medicaid claims over 11 months by exploiting suspended authorization requirements, billing tens of millions monthly for expensive compound drugs made from cheap generic ingredients through Monte Vista Pharmacy, of which California paid approximately $178.7 million before the government seized $126.5 million in assets. A Nevada woman received 54 months in prison for fraudulently claiming nearly $100 million in COVID-19 employment tax credits, while a whistleblower in the Florida case will receive $24.3 million for exposing the fraud.

Affordable Care Act Enrollment Fraud by Florida Insurance Brokers

• ▪AssuredPartners, Inc. agreed to pay $107 million to resolve allegations that AssuredPartners, Inc. violated the False Claims Act by submitting fraudulent Affordable Care Act health insurance plan applications.
• ▪AP of South Florida, LLC knowingly submitted false or fraudulent applications for subsidized Affordable Care Act plans from February 2021 through September 2022.
• ▪AP of South Florida, LLC agreed to pay restitution of $27.6 million as part of its plea agreement.
• ▪The whistleblower in the AP of South Florida, LLC case will receive $24.3 million as their share of the recovery.
• ▪AP of South Florida, LLC fraudulently enrolled consumers into fully subsidized Affordable Care Act plans for which the federal government awarded $141.5 million in unwarranted subsidies.

California Medicaid Prescription Drug Fraud Scheme

• ▪Patricia Anderson is 58 years old, from West Hills, California, and is a nurse practitioner.
• ▪Paul Randall pleaded guilty to submitting nearly $270 million in fraudulent claims to California's Medicaid program over an 11-month span.
• ▪Kyrollos Mekail is 37 years old, from Moreno Valley, California, and owned Monte Vista Pharmacy.
• ▪The government has seized approximately $126.5 million in assets that Paul Randall and his co-schemers accumulated from the California Medicaid fraud scheme.
• ▪California's Medicaid program paid at least approximately $178,746,556 of the fraudulent claims submitted by Paul Randall.
• ▪Paul Randall received approximately 40% of Monte Vista Pharmacy's profit from false and fraudulent claims at times.
• ▪Paul Randall caused at least $269,120,829 in false and fraudulent claims to California's Medicaid program from May 2022 to April 2023.
• ▪Paul Randall paid illegal kickbacks to Patricia Anderson to sign pre-filled prescriptions for 19 high-reimbursement, non-contracted, generic drugs.
• ▪Kyrollos Mekail pleaded guilty to two counts of health care fraud in August 2024 and awaits sentencing.
• ▪Monte Vista Pharmacy billed approximately $13,424 for one prescription of meloxicam 5 mg, a generic drug that typically costs between $5 and $25 for a 30-day supply.
• ▪Paul Randall agreed to forfeit property including bank account balances exceeding $17 million, three vehicles, seven real properties, and sports memorabilia.

Nevada COVID-19 Tax Credit Fraud Case

• ▪A Nevada woman was sentenced to 54 months in prison for conspiring to defraud the United States by fraudulently claiming nearly $100 million in COVID-19 related employment tax credits.

Perspective of Department of Justice

• ▪The Department of Justice announced three separate civil and criminal actions targeting approximately $500 million in fraudulent billing to taxpayer-funded healthcare programs

Perspective of California Medicaid program

• ▪California's Medicaid program paid approximately $178.7 million for fraudulent claims before detecting the Monte Vista Pharmacy scheme

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