Whistleblower gets $180,000

Staff Reports

MOULTRIE — Attorneys representing both sides of a retaliation claim against Colquitt Regional Medical Center (CRMC) revealed Thursday that the hospital will pay a whistleblower compensation of $180,000.

Joyce Dickerson, former director of CRMC’s Home Health Services, lodged claims of harassment and losing her job after she informed CRMC’s administrator and the hospital authority that she suspected that the Sylvester Home Care office was filing fraudulent claims mainly to Medicare and to a lesser extent Medicaid. CRMC earlier settled with the U.S. Justice Department to repay $475,000 for fraudulent claims. CRMC officials have said that there was no intent to defraud the government. And their attorney is saying that this settlement with Dickerson isn’t an admission of guilt.

“The hospital denies any wrongdoing whatsoever, however it agrees to pay her total compensation of $180,000,” said John Carlton, who represented CRMC solely in the fraud portion of the case.

In this round of negotiations, the plaintiffs also were entitled to $75,000 from CRMC to go toward attorney fees for the fraud portion of the case.

Carlton explained that the hospital wasn’t aware of the fraud suit until seven months after it was filed in Aug. 2004 due to the fact it was sealed even to the defendants. In Feb. 2005, the federal government filed a limited motion to lift the seal to provide the hospital and other defendants access to the allegations. At that time, Carlton said he became involved in the complicated, protracted case.

“It’s a very unusual case. It’s not like your normal lawsuit,” Carlton said, explaining that the lawsuit has never been served; therefore, no formal answer from the defendants was ever produced.

After an investigation by the Justice Department, CRMC was found to have committed civil fraud. After mediation, the government and CRMC agreed on an error rate of about 20 percent in the 496 cases the Sylvester Home Care office handled from 2001 through 2005, the time frame in which Colleen Grimsley was director of Sylvester Home Health Care. Grimsley is employed still with CRMC, the lawyers said.

“There’s no evidence that was intentional,” Carlton said.

Prior to learning of the lawsuit, CRMC Administrator Jim Lowry hired a consultant from Thomasville to pull a sampling of charts to determine if there were errors. She found an error rate of 16 percent.

The hospital authority hired North Carolina consultants, but they found 40 percent of the claims were wrong for one reason or another, Carlton said.

“Every one of those cases were where the doctors ordered the service and the service was provided,” he said. “...This ain’t no scam situation.”

The Justice Department initially was seeking $900,000 from the hospital, but the government compromised with the hospital at an error rate at about 19 percent which meant the hospital owed the government $225,000 in overbillings. In a fraudulent claims case such as this, treble damages plus penalties of $6,500 per claim are often sought, but in this case the government settled for double damages and no penalties, he said. Penalties could have mounted to more than $3,000,000 for all 496 claims, he said.

CRMC agreed to pay $450,000 to the federal government for claims to Medicare and $25,000 to the State of Georgia for Medicaid claims, Carlton said.

“I think John did a good job. I think he did a great job negotiating a good settlement with the government, because it could have been a lot higher and probably, in actuality, should have been higher,” Dickerson’s attorney Rob Howell said.

The hospital’s position likely was helped by the fact that it paid several thousand dollars in refunds back to the federal government before it knew about a lawsuit, Carlton said. Carlton said he was especially upset by the fact that neither consulting firm suggested to the hospital that it needed to pay anything back.

However, Howell said, “If in fact the hospital claims it was just a mistake or a series of mistakes, I fail to see why the hospital did not offer at any time to repay any of this money to the government and correct its mistakes.”

In 20 or 30 charts, an internal audit discovered $75,000 in overbillings, Howell noted, and CRMC didn’t offer to pay any back other than about $3,000 on one case.

As far as motive, the plaintiff contended that as director of the Sylvester Home Health Care office, Grimsley would have received bonuses, as Dickerson did, based on her annual review of which revenue is a component, Howell said.

Dickerson’s complaint detailed 11 cases.

“Earlier when she alleged fraud, she only mentioned one of them (in writing),” Carlton said. “I want to clarify that that’s the only one that we investigated.”

That claim was investigated by numerous people, including Carlton, and no fraud was found, he said.

Howell disagreed and said, “Joyce had put both Lowry and the administration on notice. She may not have used patient names, but she put them on notice that the revenue per patient in Sylvester was approximately three times higher than that in Moultrie, and that is exactly what the government found in its investigation. That was, we contended, specific enough for the hospital to know that there was a problem.

“Either people in Sylvester are three times sicker or there’s a problem,” he said

“The government’s definition of fraud includes recklessness,” Howell said. “The hospital keeps claiming that these are not intentional overbillings. To meet the definition of fraud under the ...statute, what Mrs. Dickerson needed to show was that the hospital was reckless in how they dealt with the billings, meaning that it was brought to their attention, and they turned a blind eye towards it.”

“From 2001, I can tell you with absolute certainty that no one in the hospital saw anything to indicate anybody was intentionally doing anything wrong,” Carlton said.

As parts of the conditions of the settlement with the government on the fraud portion of the case, CRMC has entered into a corporate integrity agreement and will secure an independent review organization to randomly pull charts at the end of each year and examine claims. This is in addition to internal monitoring CRMC initiated in 2004, he said. Since July of 2004, the error rate has dropped significantly, he added.

Billings out of the Sylvester office during the time in question were about 40 percent higher on average than the Moultrie office, Carlton said. That too has fallen off.

“The hospital, what they’re offering is an excuse not necessarily an explanation. They attempted to belittle the amount of money and belittle the importance of a settlement and explain it away that it was just a bunch of errors and a bunch of technicalities. And again I keep coming back to the fact that once you’re aware of that, once you hire an independent consultant who has apprised you that there are errors, why — if as you say they are just mistakes — don’t you offer to pay the money back?” Howell said.

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