Hope Cancer Institute (“Hope”) and its owner Dr. Raj Sadasivan have agreed to settle allegations by three whistleblowers in a qui tam lawsuit that they violated the False Claims Act and committed fraud against the government when they submitted falsified claims to Medicare and Medicaid. Hope, located in Kansas City, Kansas, and Sadasivan have agreed to pay $2.9 million to settle the government’s and whistleblowers’ allegations that they billed the government for larger doses of cancer drugs than were actually given to patients, and falsified the amount of time spent treating patients.
According to The Kansas City Star, three employees working in Hope’s office first uncovered the alleged fraud when they discovered medical records for a patient none of the employees recognized. In 2012, the employees, Krisha Turner, Crystal Dercher, and Amanda Reynolds, filed a qui tam lawsuit under the provisions of the False Claims Act against Hope and Sadasivan.
According to the whistleblowers’ lawsuit, they saw Sadasivan physically alter medical records with scissors and tape before he photocopied and submitted the altered records to Medicare and other government health care programs. Specifically, the whistleblowers alleged that they discovered 13 patients whose medical records had been altered to reflect that the patients received 1,000 milligrams of the intravenous chemotherapy drug Rituxan, when the patients had only received doses of 500 milligrams. The government contends Sadasivan overbilled the government by $145,000 for each patient.
In addition, according to the Justice Department, Hope and Sadasivan also submitted claims to Medicare and Medicaid for the chemotherapy drugs Avastin and Taxotere that were not given to patients. The government alleged that employees of Hope were instructed to bill for a predetermined amount of each drug at a specific dosage level, even if a lower dosage was given to the patient.
According to The Kansas City Star, Sadasivan also billed Medicare at a higher rate for more involved 25-minute patient visits when in reality, he typically spent about 10 minutes with each patient. 10-minute patient visits are billed at a lower rate.
The three whistleblowers will share in a percentage of the $2.9 million settlement proceeds as their reward under the qui tam provisions of the False Claims Act.
If you know of government fraud, click here to see if you may have a valid qui tam claim.