In a significant development concerning healthcare integrity, a Miami woman has agreed to a substantial $400,000 settlement to resolve allegations of submitting false claims that purportedly aided a New Hampshire compounding pharmacy in securing prescription approvals from Medicare. This case highlights the ongoing efforts to safeguard federal health care programs from fraudulent activities.
The focus of the allegations centers on PerforMix Specialty Pharmacy, which also operates as Granite State Compounding and Family Wellness. Reports indicate a notable surge in their Medicare reimbursements, leaping from 20% to 50%, shortly after they engaged the services of Florida-based 3rd Party Services, a company owned by Georgina Exposito, the central figure in this legal dispute.
U.S. Attorney Jay McCormack underscored the gravity of the situation, stating that “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.” He further emphasized that accountability in such cases is paramount to restoring trust in the healthcare system and protecting taxpayer dollars.
The lawsuit brought forward specific accusations against Exposito, alleging that she fraudulently altered medical diagnoses provided by prescribers. These alterations were reportedly made to facilitate the approval of expensive topical ointments under Medicare, constituting a form of Medicare fraud that compromised the system’s integrity.
A particularly striking example cited in the legal proceedings involved a diagnosis being improperly changed from osteoarthritis of the knee to actinic keratosis, a distinct skin condition. This alleged manipulation illustrates the intricate nature of the false claims and the lengths to which they purportedly went to secure reimbursements.
The alleged fraudulent conduct spanned a period from March 1, 2018, to December 31, 2019. This timeline provides a clear window into the duration of the activities under scrutiny, underscoring the sustained nature of the alleged pharmacy scam.
Under the terms of the legal settlement, the $400,000 in restitution is slated to be paid over a three-year period, incurring a 4.5% interest rate. Additionally, the whistleblower instrumental in bringing these allegations to light will receive 21% of each payment, a common provision in cases involving federal investigation into false claims.
It is crucial to note, as conveyed by McCormack’s office, that the claims resolved by this settlement remain allegations only, and there has been no formal determination of liability. This distinction is vital in understanding the legal resolution while acknowledging the seriousness of the accusations that led to the agreement.
