September 11, 2013 General

Emory University to Repay $1.5 Million Following Exposure of Fraudulent Billing Practices

In whistleblower lawsuits, individuals often reveal the dark underworld of billing schemes, theft and deceit – frequently involving organizations appearing on the surface to focus on good works and helping others. As we see more and more healthcare fraud, so comes the exposure of places like university teaching hospitals engaging in routine and systematic billing fraud, resulting in settlements with the Department of Justice and state governments for tens of millions of dollars.

As shown in the case in the recent qui tam lawsuit filed by whistleblower Elizabeth Elliot – a former employee of Emory University – teaching hospitals are becoming more and more haphazard in their quests for reimbursement from programs like Medicare and Medicaid. Perhaps, one would like to believe, these meccas of research and terminal illness treatment are merely overwhelmed by the myriad of regulations surrounding federal and state reimbursement of certain expenses. However, as is often the case, for-profit and not-for-profit organizations alike are attempting to gain from government healthcare programs with little regard for the price such behavior truly costs us all.

The details emerge as Emory University ordered to pay over $1.5 million in damages

Emory University, situated in the heart of Atlanta, Georgia, is home to a renowned School of Medicine – known to produce some of the top doctors and medical professionals in the nation. Along with a top-notch education, Emory students have the opportunity to engage in clinical trials studying certain strains of illness or injury – which in this case involved clinical trials of cancer treatment options. As Emory University worked to prepare future oncologists for a career saving and preserving lives, it failed to adhere to the federal government’s regulations– particularly with regard to certain trials that were already paid for by the sponsoring organization. As further explained by U.S. Assistant District Attorney Sally Quillian Yates, clinical trials are usually paid for by the entity seeking to test or try the treatment procedure, which is often a pharmacological or biotechnology company.

In the case against Emory, officials from the DOJ and Department of Health and Human Services uncovered routine billing practices wherein Emory administrators were invoicing Medicare and Medicaid for the administration of these clinical trials despite a guarantee of payment by the trial sponsor. In many cases, Emory University was paid twice for the same medical service, resulting in inexcusable waste of taxpayer dollars.

As Georgia Attorney General Sam Olens explained, “[c]ancer research is paramount to saving and extending lives. However, strict rules govern the use of Georgia Medicaid dollars. My office takes seriously its obligation to ensure that these resources are used properly.” This point was further reiterated by Ms. Yates, who stated “[t]reatment of cancer is expensive, and Medicare and Medicaid dollars should be reserved for patients who need services that properly may be billed to these programs.”

Blowing the whistle is not always easy, but serves the greater good

As a result of Ms. Elliot choosing to step forward and reveal the misuse of taxpayer money in clinical cancer treatment trials, she not only stands to receive a percentage of the overall settlement, but can rest easy knowing that valuable dollars are preserved for future cancer treatments benefitting patients who would be otherwise unable to pay. Whistleblowing may not win friends, but it could make a significant impact in the availability of funds to treat a terminal illness like cancer, AIDS or other life-threatening disorders.

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