Georgina Exposito, the 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 settlement was announced by Acting U.S. Attorney Jay McCormack.
According to court documents, Exposito and her company altered patients’ medical diagnoses in order to secure prior authorizations for pharmacies, including PerforMix Specialty Pharmacy in Amherst. These actions led to the submission of false claims for reimbursement from 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), added: “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 on behalf of the government when they believe false claims have been submitted. In this case, a whistleblower originally brought forward the allegations against Exposito’s company, and as part of the settlement will receive a share of the payment.
Authorities noted that these are only allegations at this stage; there has been no determination of liability regarding Exposito or her company. The government’s case against other defendants named in its complaint is ongoing.
The investigation involved multiple agencies including the Office of Inspector General for both the 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 matter.
