A Whittier, California woman is accused of taking part in a pharmacy scheme that billed Medi-Cal, the state’s Medicaid program, about $269,130,000 in false claims. Medi-Cal paid at least about $178,746,000 of them, according to the charges the Justice Department announced on October 22. The woman, Christina Mareik, has not been convicted of anything.
A pause in prior approval, and a pharmacy that allegedly used it
Medi-Cal had suspended its requirement that providers get prior authorization, which is advance approval before the program covers a drug, as part of an ongoing move to a new payment system. Prosecutors say Monte Vista Pharmacy used that gap to bill for medically unnecessary generic drugs that pay high reimbursement and fall outside Medi-Cal’s contracts.
The Justice Department says the billing ran at tens of millions of dollars a month. Its affidavit, as the release describes it, points to a patient marketer, the pharmacy’s owner and a nurse practitioner as others involved. None of them is among the 15 defendants listed in this announcement…