Emory University to pay $1.5M for overbilling Medicare, Medicaid

Atlanta's Emory University has agreed to pay $1.5 million for overbilling Medicare and Medicaid in a violation of the False Claims Act, according to an announcement from the U.S. Department of Justice.

Emory, according to the DOJ, billed Medicare and Medicaid for clinical trial research at the university's Winship Cancer Institute, despite the fact that the sponsor of the trials had already agreed to pay those costs. In some cases, the sponsor and the federal healthcare programs both paid for the same services.

"Treatment 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," United States Attorney Sally Quillian Yates said in the announcement

 "Cancer research is paramount to saving and extending lives. However, strict rules govern the use of Georgia Medicaid dollars," Georgia Attorney General Sam Olens said.  "My office takes seriously its obligation to ensure that these resources are used properly." 

The settlement was in response to a whistleblower lawsuit filed by Elizabeth Elliot, a former research finance manager at the university; Elliot will receive $322,500 of the settlement and $11,250 for wrongful termination, according to the Atlanta Business Chronicle. Approximately $70,000 will go to the state of Georgia.

The government has settled multiple Medicare-related False Claims suits this year. In July, Dubuis Health System paid the federal government $8 million over allegations that the 30-bed Southern Crescent in Riverdale, Ga., which Dubuis manages, kept patients hospitalized longer than medically necessary to increase their Medicare reimbursement. The same month, Boston's 642-bed Beth Israel Deaconess Medical Center paid $5.3 million for submitting Medicare claims for inpatient services that were actually outpatient.

According to the DOJ, Emory's settlement does not admit liability, and the claims remain allegations only.

To learn more:
- here's the U.S. Attorney's Office announcement 
- read the Business Chronicle's article

Related Articles:
Dubuis Health System settles False Claims Act allegations for $8M
Maryland General Hospital settles False Claims suit for $750K
Beth Israel to pay $5.3M to settle improper billing charges
Georgia hospital to pay $1M settlement

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