Emory University Accused of Overbilling Medicare and Medicaid for Patients Enrolled in Clinical Trial Research-Whistleblower Filed First Claim
Tuesday, September 3, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
Emory University in Atlanta, Georgia, will pay $1.5 million to settle claims it overbilled Medicare and Medicaid for cancer clinical trial services that were not permitted by the Medicare and Medicaid rules. This announcement from the Department of Justice (DOJ) was released on August 28, 2013. This case came from a whistleblower/qui tam lawsuit filed by a former research finance manager at Emory University.
Click here to read the press release from the DOJ.
Emory University Allegedly Received Payment Twice for Same Services.According to the DOJ, providers generally are not permitted to bill Medicare and Medicaid for medical care and services for which the clinical trial sponsor has agreed to pay. The DOJ alleged Emory University billed Medicare and Medicaid for services the clinical trial sponsor agreed to pay and, in some cases, actually did pay, resulting in Emory University allegedly being paid twice for the same service. Whistleblower Gets Payment for Filing Lawsuit and Wrongful Termination Claims.
According to the Atlanta Business Journal, a former research finance manager at Emory University initially filed the whistleblower lawsuit. She will receive $322,500 of the settlement, and $11,250 for wrongful termination claims. Click here to read the entire article from the Atlanta Business Journal.Under the False Claims Act (31 U.S.C. Section 3730), whistleblowers stand to gain substantial amounts, sometimes as much as thirty percent (30%) of the amount the government recovers. Such awards encourage employees and contractors to report fraud. To learn more on whistleblower cases, read our two-part blog. Click here for part one, and click here for part two.
When Health Care Providers Bill for Products They get Free, This is Fraud.We have seen many other cases where physicians and other health care providers have billed Medicare or Medicaid for items that they received free. For example, if a physician receives free vaccines from the county public health service but bills Medicaid for them, when he/she administers them to a patient, this is fraud. If a pharmacy receives free samples from a drug company but bills Medicaid for them when they are dispensed, this is fraud. If a hospital receives free medical supplies but bills Medicare for them when they are used, this is fraud.Most Qui Tams Filed by Doctors, Nurses and Employees.From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.
Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.Comments?Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.Sources:Couret, Jacques. “Emory University Pays $1.5 Million to Settle False Claims Act.” Atlanta Business Journal. (August 28, 2013). From: http://www.bizjournals.com/atlanta/news/2013/08/28/emory-university-pays-15m-to-settle.htmlDepartment of Justice. “Emory University to Pay $1.5 Million to Settle False Claims Act Investigation.” Department of Justice. (August 28, 2013). From: http://www.justice.gov/usao/gan/press/2013/08-28-13b.htmlAbout the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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Response to: Emory University Accused of Overbilling Medicare and Medicaid for Patients Enrolled in Clinical Trial Research-Whistleblower Filed First Claim
Friday, January 23, 2015
Peter J. Santos says:
In 2013 I was told that I had kidney cancer was given about 8 months of very painful chemo , was about to get a bone transplant . but would not be able to stay in the hospital for more then 2 weeks regardless of what my state of health was. I asked the doctor to write a prescription so for a 24 hour nurse . he refused said that he wouldn't . this was done after he got 8 million stem cells . the total bill about 1/4 million dollars .
And it turns out I did have kidney cancer and the cancer wasn't in my bones like is was told . I had many test before and after . Had I known I had kidney Amyloidsis .I wouldn't have gotten the chemo . the chemo is worst then the disease . I found a doctor at is treating me without chemo . I may have died from the bone marrow transplant . Also I two cyst in each kidney which Winship or Emory did find . my hearth blood pressure cholesterol are very high . This all I feel as a result of chemo and lack of care by Winship hospital . It took about 9 months bef
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