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LOS ANGELES — In what prosecutors call the largest case ever involving fraudulent medical bills submitted by a California laboratory, a federal grand jury has indicted four people on charges of billing the Medi-Cal program for nearly $20 million worth of bogus blood tests. 

The 23-count indictment handed down Wednesday names Luisa Gonzalez, 55, and Juan Carlos Ciraolo, 59, owners of the now defunct Los Angeles Bio-Clinical Laboratory in Glendale, and Roberto Calderon, 39, and Alfredo Morales, 37, operators of La Guadalupana Clinic in Hawthorne. 

The indictment charges that over a three-year-period, the defendants obtained confidential billing information about patients and doctors enrolled in Medi-Cal, the federally subsidized medical program for the poor. 

Los Angeles Bio-Clinical Laboratory then used that information to bill Medi-Cal for tests it performed on blood that was bought from donors recruited off the street, said Assistant U.S. Attorney Maurice Suh. 

Until it closed in 1997, the lab submitted bills for reimbursement totaling about $40 million; half of the bills were fraudulent, the indictment said. La Guadalupana, which offered donors cash for their blood, appears to have been the lab’s main supplier, Suh said. The money made from the fraudulent billing allegedly was laundered through Gonzalez and Ciraolo’s personal bank accounts. 

“This case represents the most unconscionable acts of health care providers who pilfer the health care delivery system, which results in higher health care costs for everyone,” said FBI Assistant Director in Charge James V. DeSarno Jr. 

Although not indicted Wednesday, a doctor who runs a San Gabriel clinic has agreed to plead guilty in connection with the alleged fraud, Suh said. An FBI affidavit said Dr. Luis Lombardi made up reports showing he had examined Medi-Cal patients and then asked Bio-Clinical to conduct comprehensive blood tests, some costing up to $550. 

Agents arrested Ciraolo and Gonzalez on Nov. 17. They were freed on $250,000 bond and are scheduled for arraignment Dec. 26. Calderon and Morales are fugitives who have fled Los Angeles, Suh said.