A physician practicing in Townshend, Vermont, paid $76,000 to the U.S. government to resolve allegations that she violated the federal False Claims Act (“FCA”) by submitting “false claims” for reimbursement to Medicare for unnecessary and unapproved “pain management” injection procedures.
The False Claims Act, passed in the aftermath of the American Civil War, and signed into law by President Abraham Lincoln, is a legal vehicle for people with knowledge about fraud on the government to recover money on behalf of the United States and to which they are entitled to a portion. If the case proves successful, the FCA plaintiff, called a “relator” or a “whistleblower,” is generally entitled to 15-30% of the recovered money.
In 2015 alone, the U.S. government recovered over $3.6 billion in either settlements or judgments in cases brought under the False Claims Act.
In this case, the U.S. Attorney for the District of Vermont alleged that Dr. Madsen “knowingly presented, or caused to be presented, hundreds of false claims for payment to the Medicare and Medicaid programs for ‘trigger point injections’ (an ‘alternative’ pain management procedure) that were not reasonable and medically necessary and which did not comply with applicable Medicare and Medicaid laws, regulations, and program requirements.”
The case was investigated by the Medicaid Fraud and Residential Abuse Unit of the Vermont Attorney General’s Office, the United States Attorney’s Office for the District of Vermont, and the Office of the Inspector General of the Department of Health and Human Services.
The government alleged that the trigger point injections performed by Dr. Madsen consisted only of saline or saline-based “anthroposophic injectates,” which did not have any health benefits, and were not considered reasonable or medically necessary under Medicare and Medicaid regulations. Pain management therapies and injections are closely monitored and regulated by the U.S. government’s Medicare program, which consults both doctors and Food & Drug Administration officials to determine which therapies and drugs the government program will carry and “cover.”
Dr. Madsen advertised on her website that“anthroposophic injectates” are a common practice in anthroposophic medicine, which “is a holistic, human-centered approach to medicine.” Generally, withstanding a few explicit exceptions, Medicare does not cover “alternative” medicines and therapies.
The Association of Anthroposophic Medicine & Therapies in America (“AAMTA”) describes anthroposophic medicine as, “being created in the 1920s by Dr. Rudolf Steiner in conjunction with Ita Wegman, and draws on Steiner’s spiritual philosophy, which he called ‘anthroposophy.’ Practitioners, whom Dr. Steiner required to be practicing M.D.’s, and which the AAMTA continues to require, employ a “variety of treatment procedures based upon anthroposophic teachings – comprising exercise, massage, counselling, and the injection or consumption of substances with healing properties.”
According to Dr. Madsen’s website, “I use saline injections. … I have treated a wide variety of symptoms including TMJ, migraines, chronic back pain, bunions, sciatica, plantar fasciitis, achilles tendonitis, restless legs syndrome, shortness of breath, frozen shoulder, and pain in any part of the body, among other conditions.”
These statements, as advertised, were cited as evidence against Dr. Madsen in the government’s complaint, and “assisted” the U.S. Attorney’s office in reaching a prompt settlement.
The settlement resolves the allegations. As is par for the course in False Claims Act settlement agreements, the agreement in this case, and Dr. Madsen’s payment to resolve the claims, “are neither an admission of liability by Madsen, nor a concession by the United States that its claims were not well founded.”
While the fraud a whistleblower sees at their workplace may not be as clear as what Dr. Madsen herself advertised, consulting an experienced whistleblower attorney or an attorney who specializes in the False Claims Act will help evaluate and guide a potential whistleblower’s claim.
Whistleblowers who bring qui tam FCA cases against companies or individuals that commit fraud against the government stand to not only disrupt dishonest and immoral practices, but often stand to recover significant financial rewards.