Big Medi‑Cal Fraud Guilty Plea

A California man admitted running a scheme that pushed nearly $270 million in false Medi-Cal drug claims through in just 11 months, and prosecutors say many of the prescriptions were either medically unnecessary or never given to patients at all. (justice.gov) The man is Paul Richard Randall, 66, of Orange, California, and the Justice Department said he pleaded guilty on April 6, 2026, to one count of wire fraud committed while on release. (justice.gov) Medi-Cal is California’s version of Medicaid, which is the joint federal-state insurance program for low-income patients, so every fake claim hits public money the way a fake invoice hits a city budget. (justice.gov) Prosecutors said Randall controlled two companies, Monte Vista Pharmacy in Los Angeles and Choice Rx Solutions in Bell, and used them to bill Medi-Cal for expensive topical medications made with cheap generic ingredients. (justice.gov) The alleged trick was simple on paper: take low-cost ingredients, package them as high-reimbursement compounded drugs, and send the bill to the state as if the product justified a far bigger payout. (justice.gov) The Justice Department said the claims were submitted from about July 2023 through May 2024, which means the scheme moved at roughly $24 million a month. (justice.gov) This was not prosecutors finding one bad bill in a stack of paperwork months later; it was a billing machine large enough to generate nearly $270 million in intended claims before the criminal case caught up. (justice.gov) Federal prosecutors first charged Randall in June 2025 during the Justice Department’s 2025 National Health Care Fraud Takedown, which covered 324 defendants and more than $14.6 billion in alleged fraud nationwide. (justice.gov) That scale is why health-payment systems now obsess over risk adjustment, chart reviews, and audit trails: once reimbursement depends on coded data moving through software, a bad actor can treat the system like a vending machine if controls are weak. (modernhealthcare.com) The Centers for Medicare and Medicaid Services has been tightening payment oversight in Medicare Advantage for the same reason, including broader audits of insurers’ submissions, because the fight is no longer just about fake clinics or fake patients but about manipulated data feeding real payment engines. (modernhealthcare.com) Randall now faces a statutory maximum sentence of 20 years in federal prison, and his plea is a reminder that in modern healthcare fraud, the weapon is often not a forged prescription pad but a clean-looking stream of claims data. (justice.gov)