Kansas cancer center settles with DOJ for $2.9 million

Hope Cancer Institute in Kansas City and its owner Raj Sadasivan, M.D., were accused of submitting Medicare claims for chemotherapy drugs that were never provided.

According to the three former employees who filed the whistle blower (qui tam) suit that the Department of Justice (DOJ) joined, between 2007 and 2011, Dr. Sadasivan instructed employees to bill Medicare, Medicaid and the Federal Employee Health Benefits Program for predetermined dosage levels of Rituxan, Avastin and Taxotere regardless of the actual dosage given to the patient. Doing so is a violation of the False Claims Act and blatant overbilling as most patients would have received a dosage that was less than the predetermined amount claimed and Dr. Sadasivan’s cancer center would have pocketed the difference in price between the amount of the drugs billed and the amount actually given.

“Health care providers that try to make a quick buck by billing taxpayers for services never provided will instead pay a high price for their greed-fueled fraud," warned Gerald T. Roy, the special agent in charge for the U.S. Department of Health and Human Services (HHS) Office of Inspector General.

The lawsuit was originally filed in the U.S. District Court for the District of Kansas by former Hope Cancer Institute employees Krisha Turner, Crystal Dercher and Amanda Reynolds. Under the qui tam provisions of the False Claims Act, which allow private citizens with knowledge of false claims to file suit on behalf of the government, they will receive a portion of the nearly $3 million settlement with the government. Typically this portion is between 15 and 25 percent, or in this case, somewhere between $435,000 and $725,000.

The case was another example of the government’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, a partnership of the DOJ and the HSS formed in 2009. According to the DOJ, since January 2009, it has recovered more than $19.1 billion through False Claims Act cases, with more than $13.6 billion of that amount recovered in cases involving fraud against federal health care programs.