publication date: Jun. 6, 2014


Kansas City Clinic Settles Medicare Overbilling Claims

A Kansas City, Kan., cancer clinic agreed to pay $2.9 million to resolve allegations that it violated the False Claims Act by submitting claims to Medicare, Medicaid, and the Federal Employee Health Benefits Program without providing those drugs and services.

The Hope Cancer Institute and its owner, Raj Sadasivan, settled the complaint stemming from allegations by employees that the clinic overbilled Medicare for chemotherapy drugs, including Rituxan, Avastin and Taxotere. The suit covered the period between Jan. 1, 2007, through Dec. 31, 2011, the settlement agreement states.

According to court documents, three HCI employees observed Sadasivan use a paper cutter and tape to alter patient records before faxing them to Medicare in order to receive inflated reimbursement.

The complaint states that Sadasivan used an unlocked electronic medical record of a “phantom patient,” named Glenna Pigg, to alter records of thirteen other patients to claim higher doses of Rituxan than the clinic actually provided.

“Specifically, the ‘locked’ EMR of those thirteen patients indicated that they had received 500 mg dosages of Rituxan, but the altered EMR that Sadasivan had faxed to CMS stated that those patients had received dosages of 1,000 mg of Rituxan,” the complaint stated. The case was settled on April 14.

According to the complaint, HCI defrauded the federal government out of about $145,000 for each of the 13 patients with altered records. The complaint also states that Sadasivan committed office visit fraud by overbilling Medicare for patient office visits.

“Patients’ office visits at HCI virtually never entailed anywhere … Continue reading 40-23 Kansas City Clinic Settles Medicare Overbilling Claims

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