Attorney General Bonta Announces Sentencing of Orange County Pharmacy Owner for $1.8 Million Insurance Fraud Scheme | State of California – Department of Justice

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OAKLAND – California Legal professional Common Rob Bonta right this moment introduced the sentencing of High quality Care Pharmacy proprietor Divina Catalasan for defrauding the Medi-Cal and Medicare applications. An audit by the California Division of Justice (DOJ) discovered that the quantity of medicine the proprietor of the Santa Ana-based pharmacy claimed to have bought and billed the applications for was not supported by her precise stock, and that her fraudulent over-billing totaled greater than $1.8 million. Catalasan pleaded responsible on Could 14, 2021, to a few felony counts of fraudulent healthcare claims and grand theft, with a sentencing enhancement for aggravated white-collar crime. She was sentenced right this moment in Orange County Superior Court docket to a few years in state jail.

“Medi-Cal and Medicare convey healthcare to seniors and folks in want, together with underserved kids and folks with disabilities. Individuals who defraud these publicly-funded applications cheat all of us,” stated Legal professional Common Bonta. “By means of our Division of Medi-Cal Fraud and Elder Abuse, the California Division of Justice works to guard Californians from healthcare fraud. Individuals who attempt to pull a quick one on these applications will probably be held accountable.” 

In 2015, an audit of High quality Care Pharmacy by the California Division of Well being Care Providers revealed that from 2011 by means of 2015, Catalasan billed Medi-Cal greater than $540,000 over what her buy stock confirmed. The division then referred the case to DOJ’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA), which expanded the audit and the time-frame below assessment. DMFEA additionally expanded its audit past Medi-Cal to Medicare and Orange County’s Medi-Cal managed care plan, CalOptima. The expanded audit discovered that Catalasan fraudulently overbilled Medi-Cal and CalOptima for $1,168,585.06, and Medicare for $687,940.52, for a complete of $1,856,525.58. She was arrested on June 11, 2019.  

By means of the DMFEA, DOJ works to guard Californians by investigating and prosecuting those that perpetrate fraud on the Medi-Cal program. DMFEA additionally investigates and prosecutes these liable for abuse, neglect, and fraud dedicated in opposition to aged and dependent adults. The division often works with whistleblowers and legislation enforcement businesses to research and prosecute crimes. 

The DMFEA receives 75% of its funding from the U.S. Division of Well being and Human Providers below a grant award totaling $41,264,032 for federal fiscal yr 2020-2021. The remaining 25%, totaling $13,754,675 for fiscal yr 2020-2021, is funded by the State of California. The federal fiscal yr is outlined as by means of September 30, 2021.

A duplicate of the grievance is offered here.

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