The Justice Department announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss.

And reaching across the country, the U.S. Attorneys office for the Central District of California announced that an Orange County man, who’s name might have a familiar ring to the worker’s compensation community, has just been charged via federal criminal complaint with submitting nearly $270 million in fraudulent claims to Medi-Cal, over an 11-month span, for expensive prescription drugs containing generic ingredients that were not medically necessary and, in many instances, not provided to the purported recipients.

66 year old Paul Richard Randall is now charged with health care fraud, a felony that carries a statutory maximum penalty of 10 years in federal prison.Randall made his initial appearance in United States District Court in Los Angeles on Friday and was ordered jailed without bond. His arraignment is scheduled for July 17.

Randall has a long criminal history as he reportedly began his career as a hospital marketer in the mid-1990s after serving a stint in federal prison for racketeering. He was convicted of the felony in 1993 for deals that involved buying wooden shipping pallets on credit and reselling them without paying the original vendors, and was sentenced to a 21-month term. After serving time in the Terminal Island federal correctional facility in Long Beach harbor, Mr. Randall went into business with Michael D. Drobot, the owner of Pacific Hospital of Long Beach.

Drobot pleaded guilty to criminal charges related to paying more than $20 million in kickbacks and bribing California state Sen. Ron Calderon to preserve a loophole in state law that enabled him to charge insurers sky-high prices for spinal hardware used at the Pacific Hospital of Long Beach. The FBI has said the kickbacks-for-surgeries scam is believed to be the largest in California history.

After a business dispute between the two men, Randall moved to Tri-City Regional Medical Center in Hawaiian Gardens in 2008, a hospital eight miles away that then focused on bariatric surgery. Tri-City, which is a nonprofit institution, paid Mr. Randall more than $3.2 million between 2008 and July 2011 as a business-development consultant. Mr. Randall recruited some of the same spine surgeons to Tri-City that he earlier introduced to Mr. Drobot at Pacific Hospital.

By August 2011, Mr. Randall said, he was back to doing spine-surgery marketing work for Mr. Drobot at Pacific Hospital of Long Beach. Randall reportedly said he signed a $100,000-a-month marketing agreement with Mr. Drobot – technically between Mr. Drobot’s spinal-implant distributorship and a Randall marketing firm – under which Mr. Randall was to provide services such as “recruiting surgeons to the medical staff of hospitals that use” implants Mr. Drobot distributes. Drobot disputed signing such an agreement.

Randall pleaded guilty on April 16, 2012 to conspiracy to commit mail fraud. Randall admitted recruiting chiropractors and doctors to refer patients to Tri-City in exchange for kickbacks. Randall’s guilty plea in 2012 and agreement to cooperate in “Operation Spinal Cap” suggest he provided information to federal investigators, potentially implicating others in the Pacific Hospital and Tri-City schemes.

However, his 2017 arrest for violating pre-sentencing release terms in the Tri-City case and subsequent fraud allegations indicate continued criminal activity. A judge denied bail on October 23, 2017, ordering Randall to remain in custody at the Santa Ana city jail until sentencing. His sentencing was advanced to November 17, 2017, from December 22, 2017. Prosecutors sought a sentence of 37 to 46 months in prison, plus restitution.

Randall incorporated a company, Pharma Pro Solutions, in 2016, which was implicated in a scheme to defraud the University of California’s Student Health Insurance Plan (UC SHIP). The scheme allegedly stole student health plan ID numbers to bill $12 million for compound drugs over six months starting in October 2016. The Regents of the University of California amended a civil complaint in July 2017, filed in Los Angeles County Superior Court, alleging Randall’s involvement. The scheme involved recruiting students to apply for positions selling topical creams, requiring them to provide UC SHIP numbers and fill out health history forms, or offering payments for participating in “clinical trials” of pain creams.

Also, in what may be characterized as a federal lawsuit pieced together from evidence that exists across existing criminal and civil litigation, 14 AIG insurance related companies sought restitution from nearly 30 named defendants who it claims fraudulently or illegally made claims for payment for providing worker’s compensation treatment on cases where AIG entities provided coverage. The 22 page federal lawsuit filed on October 31, 2017 listed Paul Richard Randall as one of the named defendants.

According to an affidavit filed with the newest complaint, Randall, Kyrollos Mekail, 37, of Moreno Valley, and Patricia Anderson, 57, 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 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 included Folite tablets, a vitamin available over the counter.

Normally, these high-cost reimbursement medications would have required prior authorization under Medi-Cal’s old payment system. Medication involved in this scheme was medically unnecessary, frequently was not dispensed to patients, and procured by kickbacks.

From May 2022 to April 2023, Monte Vista billed Medi-Cal more than $269 million and was paid more than $178 million for 19 expensive, non-contracted drugs containing low-cost, generic ingredients that were not medically necessary, not provided, or both.

Randall and others then allegedly 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.

Relatedly, Anderson was charged in a two-count information charging her with health care fraud for her role in the scheme which was unsealed last week. Mekail pleaded guilty to criminal charges in August 2024 and awaits sentencing.

As a result of the national takedown, the government seized more than $245 million in cash, luxury vehicles, cryptocurrency, and other assets as part of the coordinated enforcement efforts. As part of the whole-of-government approach to combating health care fraud announced today, the Centers for Medicare and Medicaid Services (CMS) also announced that it successfully prevented more than $4 billion from being paid in response to false and fraudulent claims and that it suspended or revoked the billing privileges of 205 providers in the months leading up to the Takedown.