The University has agreed to pay $1.5 million in legal fees to settle claims that it overbilled Medicare and Medicaid for some patients in Emory's Winship Cancer Institute from 2001 to 2010, the U.S. Attorney's Office said last week.
The University reached the civil settlement with the U.S. Attorney's Office for the Northern District of Georgia and Attorney General, according to an Aug. 28 press release issued by the U.S. Attorney's Office for the Northern District of Georgia. Elizabeth Elliot, a former clinical research finance manager at Emory, filed the lawsuit that led to the settlement in 2009.
The allegations state that the University billed two separate entities – Medicare/Medicaid and a clinical trial sponsor – for the same medical care and services, according to the settlement. The clinical trial sponsor had agreed to pay for the medical services that the University then charged to Medicare and Medicaid. In some cases, Emory was paid twice for the same services, according to the press release.
All claims in the settlement are allegations, and Emory has not agreed or admitted any liability, the press release said.
The alleged actions violated the False Claims Act, a federal law that holds a person or entity liable when they improperly receive payment from the government, the press release said.
Elliot filed the lawsuit that led to this settlement under a False Claims Act provision that allows private citizens to take on civil actions for the government, according to the settlement.
The quality of Emory's patient care or clinical research was never in question in this settlement, said Nancy Seideman, Emory's interim vice president for communications and marketing.
"Emory has been working to improve its clinical billing process for the past decade," she wrote in an email to the Wheel. "Emory had invested significant resources to enhance [the] process and we will continue to devote resources to improve integrity of our processes and compliance programs."
Elliot will receive more than $300,000 for expenses, attorneys' fees and costs, according to the settlement.
The state of Georgia will receive about $70,000 of the settlement, the settlement said.
The settlement states that the parties agreed to the settlement "to avoid the delay, uncertainty, inconvenience and expense of protracted litigation."
Derrick L. Jackson, special agent in charge of the U.S. Department of Health and Human Services' Office of Inspector General for the Atlanta region, said in the press release that his office conducted the investigation that led to the settlement.
"Protecting Medicare – and taxpayer dollars – remains a top priority," he said in the press release.
U.S. Attorney Sally Quillian Yates said the settlement shows that her office is committed to protecting "crucial Medicare and Medicaid dollars."
"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," she said.
– By Karishma Mehrotra
Correction 9/4:
U.S. Attorney's Office for the Northern District of Georgia issued the press release, not the F.B.I.
The settlement stated what Emory will pay the state of Georgia and Elliot, not the press release.
Elliot will be paid $300,000 for expenses, attorneys' fees and costs, not in settlement payment.
