February 26, 2007
Moultrie - Colquitt Regional Medical Center has agreed to pay the U.S. Government $475,000 to settle fraud allegations.
Joyce Dickerson, a registered nurse and director of Moultrie Home Care Services, filed a lawsuit in August 2004. She claimed Colquitt Regional Medical Center's Home Health office in Sylvester accepted Medicare or Medicaid reimbursement between 2001 and 2005 on cases that didn't qualify for reimbursement.
Hospital Authority Chairman Durwood Dominy said any inappropriate claims were submitted unintentionally, and the hospital was unaware of the problem.
He says all services were provided under the direction of the patient's physician.
Here is the hospital's complete statement:
Colquitt Regional Medical Center has agreed to pay the United States government $475,000 to settle allegations that it violated the False Claim Act by filing for Medicare and Medicaid reimbursement on cases that did not qualify.
The Justice Department charges stemmed from cases submitted for Medicare and Medicaid reimbursement by CRMC's Home Health office in Sylvester from 2001 to 2005.
The Justice Department conducted an investigation of the hospital's Sylvester Home Health office after a whistleblower filed a lawsuit on Aug. 17, 2004 claiming that the Sylvester office had accepted reimbursement on cases that did not qualify for Medicare or Medicaid reimbursement.
After a detailed year-long investigation of Home Health records, the Justice Department and Colquitt Regional Medical Center reached a compromise on an "error rate" on which to base the final settlement.
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," Dominy 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.
Dominy said the reimbursement to be made by the hospital is based on claims that had technical errors such as beginning home care services for patients on a physician's verbal orders instead of a signed document.
"There are 140,000 pages of regulations that deal with Medicare reimbursement," Dominy 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."
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