Emory University agreed to pay $1.5 million to settle False Claims Act allegations raised in Elizabeth Elliott’s qui tam complaint. Elizabeth Elliott was a Clinical Research Finance Manager at Emory University from September 2008 until November 2009. For taking action, Ms. Elliott will receive a qui tam reward of at least $225,000.

Ms. Elliott’s Complaint described a “Legacy Study Project,” an internal investigation into fourteen studies conducted at Emory’s Winship Cancer Institute. According to Ms. Elliott, in these fourteen studies, Emory had improperly billed the participants for a co-pay and/or billed the participants’ insurance provider, including Medicare and Medicaid, for services rendered. As participants in the research study, however, the costs in question should have been billed to the respective study’s sponsor.

Ms. Elliott was troubled that Emory allegedly only looked into these fourteen studies, where the participants had specifically complained about the supposed improper billing. According to Ms. Elliott, “there were hundreds of legacy studies that had followed the same billing procedures and thus likely contained the same improper billings.”

The allegations raised in this case highlight a common occurrence in healthcare fraud. Namely, health care providers will oftentimes myopically focus on the specific issues raised by concerned patients, government auditors, and employees. However, these identified problems are, very often, the tip of the proverbial iceberg and are not-too-subtle hints that a larger, systemic problem exists. Unless a more comprehensive examination is taken of improper billings, the health care provider risks rack up substantial liability under the False Claims Act.

More information for whistleblowers is located at the Nolan Auerbach & White website.