When Vicki Hewitt-McNeil read about WakeMed’s $8 million settlement for wrong Medicare billing, the Raleigh nurse didn’t buy the story.

According to the settlement, a nursing director instructed her staff to admit patients as inpatients and ignore doctors’ orders to treat them on the less expensive outpatient basis.

With two decades of nursing experience, Hewitt-McNeil didn’t like that the blame was shifted down the totem pole to nurses, who don’t wield the power of administrators and doctors.

“I honestly cannot believe this was the nursing department that did this,” Hewitt-McNeil said. “That’s just not possible.”

Hewitt-McNeil, who first made her opinion known in a letter to the editor in The News & Observer, has two decades of nursing experience. She worked at Duke University Hospital for 10 years, as a manager at Dorothea Dix Hospital and at nursing homes. She also worked shifts at WakeMed as a pool nurse, similar to working as a substitute teacher. “Nurses at WakeMed don’t have the autonomy to do anything,” Hewitt-McNeil said. “You have to call a doctor for everything.”

Debbie Laughery, WakeMed’s spokeswoman, said the agreement struck with federal investigators prohibits the hospital from discussing the case or Hewitt-McNeil’s comments.

But the nurse’s comments show that it may take some time for WakeMed to shake off the effect of the first federal sanction in the 52-year-old hospital’s history.

The federal investigation began in 2007, when auditors noted that WakeMed had the highest level in the state of “zero-stay days,” when the hospital billed for expensive overnight stays when the patient had been treated and discharged the same day.

The problem cases were all in WakeMed’s heart center, which has long served as the hospital’s big money maker.

According to the settlement, WakeMed’s director of Patient Access ran a staff that routinely ignored doctors’ orders about how to classify patients at the cardiac center. Sometimes doctors sent orders without classifying a patient, and nurses failed to consult doctors before billing Medicare for the pricier inpatient services. In other cases, the nurses ignored written physician orders to treat patients as outpatients

Heidi McAfee, who retired earlier this year, was the nursing director responsible for the billing changes during most of the period. McAfee did not return telephone messages left last week.

In an interview earlier last week, WakeMed CEO Bill Atkinson declined to discuss McAfee. “I don’t want to talk about Heidi,” Atkinson said. “She’s somebody who did a great job and tried to get it right in our opinion.”

Atkinson blamed the problem on erroneous interpretation of complicated Medicare regulations. He said WakeMed agreed to pay back the money when it was first brought to its attention. Federal authorities said WakeMed has been cooperative throughout.

News of WakeMed’s settlement caused other area hospitals to examine their billing practices.

Rex Hospital officials called a meeting of case managers the next morning to make sure their billings were in order. “When there is significant news about any hospital, but especially another local hospital, it is a good opportunity to discuss the problems they encountered, and what we can learn from their experience,” said spokesman Alan Wolf in a statement.

Duke University Hospital and UNC Hospitals had similar discussions, spokeswomen said. Hewitt-McNeil said it’s difficult for many nurses to speak up in these situations.

“Nurses may not talk about it among themselves,” Hewitt-McNeil said. “They may not speak up out of fear of their job or repercussions.”

Neff: 919-829-4516