Fired WellStar exec points to financial improprieties
by Jon Gillooly
jgillooly@mdjonline.com
April 06, 2011 12:00 AM | 20263 views | 42 42 comments | 55 55 recommendations | email to a friend | print
WellStar’s new period of expansion with construction of the Kennestone Outpatient Pavilion has taken a backseat to recent controversies.<br>Staff/Laura Moon
WellStar’s new period of expansion with construction of the Kennestone Outpatient Pavilion has taken a backseat to recent controversies.
Staff/Laura Moon
slideshow
MARIETTA - The former president of WellStar Medical Group believes he was fired to prevent him from going public with alleged billing and revenue improprieties by some WellStar physicians.

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."
Comments
(42)
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anonymous
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April 20, 2011
Morgan....come on? Your comments above are ridiculous. You are a very well versed liar. How many years did it take you to perfect this kind of language? The doctor is trying to express a very large concern. Over billing is a problem and also fraudulent and against the law. The woman who expressed to the doctor to correct her medical record for faulty billing could have sued the doctor as well. This is on HER medical record. How would you like it if false documentation was made on your medical record ? It could inhibit you from having individual insurance for "having previous condition". To the doctor, I understand that medical billing is difficult matter with regard to insurance payments but you can't lie on a record to achieve reimbursement to your satisfaction.
What else is new
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April 18, 2011
Doctor you are right. The morale of Wellstar has gone right down the drain. It is a shame what is happening. I am afraid it comes down to a couple things. Greed and power. Both lead to evil.
angry MD
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April 15, 2011
Interesting how Wellstar gives it's employees 15 days notice that they can't see their Emory physicians anymore. Great! Just another way to force everybody to use Wellstar facillities. David Anderson needs to be fired!
Mike Jones
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April 14, 2011
Folks, if you don't like Wellstar, there's alway's Grady.......
L. P. green
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April 08, 2011
I have been a physician at Wellstar for greater than 15 years,and it has become a miserable environment in which to be employed.The administration is dysfunctional,is hostile towards non employed physician staff and as a result there exist little civility between Wellstar and non Wellstar physicians.This in my opinion clearly effects patient care .Wellstar as a management organization has been an immense failure.I risk great retribution for making such comments.
cobb manager
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April 08, 2011
Wellstar has no integrity and I hate working there and peddeling their drek but I need a job close to home for personal reasons.There are a great deal more employees who feel the same way and who have no loyalty to the system
kennestone nurse 214
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April 08, 2011
One of the doctors who is a cardiologist for wellstar told me that Wellstar purchased their practice because hospital systems are allowed to submit institutional charges for diagnostic services such that a nuclear medicine cardiac stress test that might have cost 600 dollars prior to the wellstar physician practice acquisition would now be billed out at three times that cost.I guess this is what happens when a system like Wellstar attempts to eliminate all the competition in the area.Yes Wellstar believes in a life(patient) well hosed!
wellstar pimp
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April 08, 2011
@ stay tuned....you are sooooo right. We have lost ALOT of good managers due to the survey. That survey is set up to intiidate managers. My director begged us to participate and give top scrores. Subsequently she did not get what she needed and she was fired!Wellstar is corrupt in so many ways and their day is coming VERY soon!!!!!!!!!!!!!!!!!!!!!
giftgivernomore
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April 07, 2011
I for one am reconsidering my gift giver fund donations. If there is so much $ floating around for severance packages, fat administrative paychecks, plane trips and construction, why should I donate $ from my paycheck to an organization which has proven to be dishonest, unethical and less than transparent.
stay tuned
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April 07, 2011
To WellStar pimp,

The only problem is tht it bites the Manager of the Department in the BUTT and not Leadership. Managers have been fired for low scores. To add insult to injury there is not even a place on the survey to write in comments. It STINKS! ! ! !
long time resident
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April 07, 2011
First it is the Cobb County School Board--Now it is Wellstar. What is happening in a County that we all love???Very sad
wellstar pimp
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April 07, 2011
LOL @ stay tuned. Employee engagement is going to be really low. There will be low numbers and low participation. Wellstar is Hellstar. Wellstar thought that because the economy is soo bad, that they could do what they wanted. It's about to bite them in the Butt bigtime!!!!!!!!!!!!!!!!
big $$$$$$$ MD's
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April 07, 2011
Geez, what about these huge exorbitant salaries at the "not-for-profit" health system. Dr. Lopes $550K salary = are you kidding me ?!?! Primary Care MD's only make $150K/year...and there are other MD managers at Wellstar who pull down $300K/year, and don't see a single patient...how absolutely disgusting. Cobb Public Health District Director Dr. Jack Kennedy, a true local MD health leader, runs a real non-profit community healthcare organization, and probably makes a third of what Dr. Lopes made.
keepinitreal
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April 06, 2011
Classic whistle blower story. Who is running the show and why aren't they gone too?
Harvey Wallbanger
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April 06, 2011
The problem with WellStar lies with one person, Human Resource Director and Chief Compliance Officer David Anderson. His back door deals with the State, his cover-ups, and his fake stories concerning Dr. Simone are sickening. He is a bad, bad person who must go. Once this "cancer" is cut out, WellStar can fix their billing and compliance issues and return again to the quality health care organizaton it once was.
Question22
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April 06, 2011
Can you clarify for us: Did the board chairman and or board as a whole authorize the firing of Lopes and Strachan or did Budzinski do this on his own? It would really help to clarify the situation to understand WHO is responsible for this decision.
Stay tuned
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April 06, 2011
Stay tuned for the next exciting episode of As the World turns in the Days of our Lives at WellStar.

Leadership may want to think twice about doing the employee survey's right now. Moral is really low.
onlymoney
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April 06, 2011
I use to work for Wellstar and they hired a Dr from another local hospital. There was a clause in the Drs contract from the other hospital that states he couldn't have a office with in 25 miles. The CEO at the time, moved him right next to a Wellstar hospital. The Dr, DO and the office manager told everyone(employees) that "it's only money". It really made me angry cause Wellstar doesn't like to give raises to us "little" people.
TRUTH HURTS
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April 06, 2011
THE WHOLE MEDICAL SYSTEM IS A FRAUD. IT'S GOING TO GET A LOT WORSE WITH OBAMADOESNTCARE!
anonymous
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April 06, 2011
Wellstar pimp, don't make accusations that you know nothing about. There are actually two board members who are African Americans. The ignorance of some of these posters is amazing.
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