MOULTRIE — Following a U.S. Department of Justice investigation, Colquitt Regional Medical Center (CRMC) agreed to pay the federal government $475,000 to settle fraud allegations.

The federal whistleblower case, which was filed Aug. 17, 2004, remained sealed until Wednesday. It centered around a series of claims submitted for Medicaid and Medicare reimbursement by CRMC’s Home Care Services office in Sylvester from 2001 to 2005.

Plaintiff Joyce Dickerson, a registered nurse and former director of the Moultrie Home Care Services office, allegedly reported to the hospital administration and the hospital authority in 2004 what she believed to be years of illegal billing. While hospital officials say the settlement was based on an “error rate,” Dickerson’s attorney Robert Howell of Moultrie said in actuality CRMC owes the federal government double the compromise agreement.

In the complaint, CRMC was alleged to have received payment from Medicare for services that were not reasonable and necessary, upcoded certification diagnoses so that the hospital was overpaid by Medicare and underutilized services after being paid in advance by Medicare allowing defendants to receive payment from both Medicare and patients.

During the time of the alleged fraud, defendant Colleen Grimsley of Sylvester had been director of the Sylvester office until 2004 when Dickerson assumed directorship of both offices. Grimsley would have had financial incentive to commit the alleged fraud, Howell said. Revenue was a component of the home health directors’ annual review, he said.

“All she [Dickerson] really wanted to do was to bring this to the attention of the administration and make it stop, because she feared for her own license and she also feared for the organization she worked for,” Howell said. “She brought it to their attention, they didn’t do anything to stop it and so she felt compelled to go to the next level with it, so that’s just what she did.”

This investigation and the resulting settlement vindicates his client’s assertions, Howell said.

“My client has been vindicated and the taxpayers, who ultimately foot the bill for this type of illegal conduct, have also been vindicated,” the attorney said. “Mrs. Dickerson is an extremely courageous woman who has sacrificed much and has suffered greatly to make sure that CRMC repaid the money it over-billed and wrongfully collected from the government’s Medicare program.”

Durwood Dominy, chairman of Colquitt County Hospital Authority, said any inappropriate claims submitted were unintentional and that the hospital had no indication of problems during the five-year period.

“All home care services were provided under the direction of and on orders by the patients’ personal physicians,” he pointed out. “All nursing care plans were ordered by the personal physician and payments to Colquitt Regional for services provided were made after a Medicare intermediary signed off on them with no qualifications or audits during this five-year period.”

Dominy said the hospital had measures in place to ensure that claims were properly submitted for reimbursement.

“All claims were submitted to and reviewed by an independent third party, which is the intermediary between the hospital and Medicare, and none of the claims were disapproved,” he said. “There was absolutely no indication that anything was wrong.”

Dominy pointed out that when allegations were first made, prior to the Justice Department’s investigation, that Colquitt Regional had its compliance officer, two attorneys and then two outside consultants to review the records and none found any fraudulent practices.

The authority chairman said the reimbursement to be made by the hospital is based on claims of technical errors such as beginning home care services for patients on a physician’s verbal orders instead of a signed document.

“If was just a technical error, why didn’t the hospital ever offer to repay the money to the government?” Howell posed.

“The allegations were nonspecific,” said CRMC Public Relations Director Gary Boley, saying that was a reason for a number of internal investigations. “There was never anything to look for, because they weren’t that specific — general in nature.”

“I think there was one specific one that I know of. They specifically looked at that one and found no fault with it,” Dominy said.

“We were very specific,” Howell countered.

The complaint listed details of 11 patient cases as examples of the allegations including dates of service.

“There are 140,000 pages of regulations that deal with Medicare reimbursement,” he said. “It makes it extremely difficult for hospitals to operate when there are that many regulations that are constantly changing, especially when you consider the hospital’s revenue volume. During that five-year period, more than a half-billion dollars flowed through Colquitt Regional Medical Center.”

“Any attempt by CRMC to belittle the importance of this settlement, their conduct or the amount paid is disingenuous — $475,000 is a lot of money. In my experience, companies don’t pay that kind of money to settle claims unless the claims have merit,” Howell said.

“The government’s investigation was extensive — two years long,” he said. “The U.S. Attorney and his investigators team came to Moultrie several times during those two years, met with me, met with Joyce, met with witnesses who were mainly ex-employees of CRMC, subpoenaed, collected and reviewed literally thousands of records, hired their own experts. So it’s not as if they didn’t take a hard look at this for a long time. And ultimately, they decided that Joyce was correct — what she alleged was going on there was going on there.”

Pending still is a related lawsuit against CRMC and its CEO Jim Lowry for alleged retaliation against Dickerson that caused her to lose her job. Discussions of a settlement in that case begin next week. Dickerson is seeking damages for the loss of her job, back pay, compensatory damages and attorney’s fees.