Source: Office of United States Attorneys
CONCORD –Georgina Exposito of Florida, owner of 3rd Party Services of Florida, agreed to pay $400,000 to resolve allegations that they violated the False Claims Act (FCA) by submitting false claims to Medicare and TRICARE based on fake medical diagnoses, Acting U.S. Attorney Jay McCormack announces.
According to the settlement agreement and the complaint in partial intervention, Exposito and her company altered patients’ medical diagnoses to obtain prior authorizations on behalf of pharmacies, including PerforMix Specialty Pharmacy, a compounding pharmacy located in Amherst. This resulted in the submission of false claims to Medicare and TRICARE.
“Submitting false claims to federal health care programs like Medicare and TRICARE undermines the integrity of our health care system and diverts critical resources away from patients who need them,” said U.S. Attorney Jay McCormack. “Accountability in cases like this helps restore trust in our health care system and ensures taxpayer dollars are protected.”
“The submission of falsified prior authorization requests undermines an important safeguard against unnecessary Medicare costs,” said Special Agent in Charge Roberto Coviello of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “This settlement highlights HHS-OIG’s ongoing commitment to combatting fraud in the taxpayer-funded Medicare program, and we will continue to thoroughly pursue allegations of False Claims Act violations.”
The False Claims Act permits whistleblowers to file civil lawsuits alleging that false claims have been submitted to the United States. This FCA settlement resolves allegations against Georgina Exposito’s company originally brought in a lawsuit filed by a whistleblower. As part of the settlement the whistleblower will receive a portion of the settlement amount.
The claims resolved by the settlement are allegations only, and there has been no determination of liability. The United States’ case against the other defendants named in the complaint in partial intervention continues.
This case was investigated by the Office of Inspector General of the U.S. Department of Health and Human Services, the Office of Inspector General of the Department of Defense, and the Federal Bureau of Investigation. The case is being handled by Assistant U.S. Attorney Raphael Katz.
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