Georgina Exposito, a Florida resident and owner of 3rd Party Services of Florida, has agreed to pay $400,000 to settle allegations that she and her company violated the False Claims Act by submitting false claims to Medicare and TRICARE. The allegations stem from accusations that Exposito and her business altered patients’ medical diagnoses in order to obtain prior authorizations for pharmacies, including PerforMix Specialty Pharmacy located in Amherst. These actions allegedly led to the submission of fraudulent claims to federal health care programs.
“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.”
Special Agent in Charge Roberto Coviello of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), commented on the case: “The submission of falsified prior authorization requests undermines an important safeguard against unnecessary Medicare costs. 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 allows whistleblowers to file civil lawsuits regarding false claims submitted to the United States government. In this instance, the settlement resolves allegations originally brought forward by a whistleblower lawsuit, with the whistleblower set to receive a portion of the settlement.
Officials noted that these are only allegations and there has been no determination of liability. The government’s case against other defendants named in the complaint is ongoing.
The investigation was conducted by multiple agencies, including the Office of Inspector General for both the U.S. Department of Health and Human Services and Department of Defense, as well as the Federal Bureau of Investigation. Assistant U.S. Attorney Raphael Katz is handling the case.
