The health system's attorney denies the allegation.
WellStar Health System Interim CEO Jim Budzinski terminated Dr. Richard Lopes on March 21 without cause. WellStar claimed in a press release that Lopes had resigned.
Not true, Lopes said in a March 24 letter to Budzinski.
After being called into a meeting with Budzinski and David Anderson, WellStar's Human Resources director, Lopes was terminated without cause effectively immediately, entitling him to 90 days notice and severance pay.
"After being terminated without explanation, I then was instructed to vacate my office that day," Lopes wrote. "I was escorted back to my office, where my computer had already been removed, and then was told to leave the building and that I could return later that evening after business hours to remove my remaining personal items."
Such treatment reflects "a lack of courtesy and respect for the service I provided to WellStar and also calls into question WellStar's motives for terminating me," he wrote.
Lopes said a complaint was made in January through the WellStar hotline from a husband and wife who have been long-term patients of Dr. Lamar Cousins. Cousins, who has practiced internal medicine in Marietta since 1974, formerly practiced with the late Dr. Robert Lipson before Lipson became WelStar's CEO.
The Journal contacted Cousins' office requesting an interview, but received no answer by press time Tuesday.
According to Lopes, the husband and wife had recently seen Cousins for routine care and received a bill that included the diagnosis of chest pain to justify payment for a chest X-ray and EKG conducted in his office. The wife said she wanted her medical record to be corrected and payment for the tests refunded. She also wanted an apology from Cousins.
Writes Lopes: "The initial results of an audit of 50 charts revealed that there was a pattern of lack of documentation to support ancillary testing; there appeared to be excessive use of diagnostic codes that would qualify patients for additional services; and, in the case of the two patients who made the complaint, the information raised the concern that Dr. Cousins or someone in his office falsely assigned the diagnosis to support the insurance claim ... During the course of the investigation, Dr. Cousins cavalierly made the comment that 'all insurance was a game' or words to that effect."
When confronted about the findings, Cousins showed no remorse for his patients' concerns and denied any wrongdoing, although he was forced to sign a letter of apology to the patients who complained, according to the letter. Moreover, he and his staff had to participate in coding compliance education, Lopes said.
"Subsequently, you were notified of this situation and were told by Mr. Anderson and (WellStar attorney Leo Reichert) that there was a significant possibility that suspected billing fraud would be reported to CMS (the federal Centers for Medicare & Medicaid Services), necessitating a comprehensive chart review of Dr. Cousins' practice," Lopes said in his letter to Budzinski.
Lopes said it is noteworthy that Cousins is one of five physicians who met with WellStar Board of Trustees Chairman Randall Bentley, board member Tom Phillips and Budzinski to complain about a plan to convert the physician practices within the WellStar Medical Group to a single tax ID number, implement a system-controlled, single-billing system, and take appropriate control of the revenue cycle. Those proposals were made to correct longstanding issues regarding the lack of consistency and appropriate oversight coding and billing among many of the physician practices with the Medical Group, according to the letter.
"In fact, several of the physicians who have expressed objections to standardizing the Medical Group have been the subject of improper billing compliance issues," Lopes wrote. "They also have outside relationships with labs and ancillary providers that bring them significant revenue at the expense of the WellStar Health System. In other words, there is a personal financial motivation not to convert to a single, centrally managed billing operation."
Lopes believes the long history of multiple billing entities, multiple billing systems, physician office-based billing outside the central business office, and in some cases an inability to easily review important operational and compliance information within the practices had "created an environment within the medical practices that rewards poorly delivered, often inappropriate care without regard to system standards or compliance guidelines."
Such procedures were allowed during Budzinski's tenure as chief financial officer and as interim CEO, Lopes said.
"Despite my concerns, this inappropriate environment was not only tolerated, but facilitated through you and board members' personal relationship with a number of the most egregious offenders," he wrote.
Such behaviors by Budzinski "seriously jeopardize the organization going forward," he said.
Lopes also makes reference to an analysis performed by CBIZ that found "there are issues regarding overpayment of physicians."
The Journal asked for a copy of the CBIZ analysis, but was told by spokesman Keith Bowermaster that it is "confidential and is a part of our legal and compliance process, and is not subject to the Open Records Act."
Continued Lopes in his letter: "Based on all this information, I can only conclude that my termination was designed to prevent me from either reporting or making public the issues regarding the above-described billing and revenue improprieties. Moreover, I believe WellStar has described my termination to the public as a resignation in order to avoid any appearance of impropriety," Lopes writes.
WellStar attorney Sharon P. Morgan with the firm of Elbarbee Thompson answered Lopes' allegations in a letter dated March 29.
Morgan said any suggestion that his termination was related to concerns about reporting compliance issues is wrong. The compliance issue Lopes raises in his letter has already been identified and is in the process of review and investigation, she said.
Morgan also points out that Lopes tried to resign in January because he did not consider himself "a good fit" with WellStar, but ultimately decided to retract that decision.
As for WellStar's false announcement that he had resigned and not been terminated, "that was offered as a favor to you," she said. "This was not an attempt to sidestep WellStar's contractual obligations, rather it was a gesture made out of courtesy."
Morgan said WellStar never made any effort to stifle his ability to raise concerns about billing and revenue improprieties, and only encourages such reporting.
"Much of your letter expresses frustration at the pace of integration of the Medical Group and apparent disagreement with management," Morgan writes.
"Your summary of these issues is both self-serving and inaccurate. In any event, issues relating to the structure and operations of the Medical Group, including the fact that the Medical Group's billing and finance functions report through the hospital's business office, have been and continue to be issues for WellStar as it works through the process of integrating the many physician practices which comprise the Medical Group into a single group. These issues were present throughout Dr. Simone's tenure as CEO, and, unfortunately, they will not be resolved overnight."