WellStar repays $2.7M in excessive refunds
by Brandon Wilson
bwilson@mdjonline.com
September 04, 2010 12:00 AM | 7510 views | 27 27 comments | 56 56 recommendations | email to a friend | print
MARIETTA - WellStar Health System has settled a six-month investigation by paying back $2.73 million in excessive Medicaid reimbursements the health care provider received, Attorney General Thurbert Baker announced early this week. WellStar's acting president admitted the health system did not have adequate measures in place to spot the overpayments.

The investigation focused on claims made by patients enrolled in both Medicare and Medicaid.

"The investigation found that WellStar filed claims which did not reflect the full amount of Medicare prior payments, allowing WellStar to receive excessive Medicaid reimbursements," according to the Attorney General's Office.

For patients covered under both federal health plans, Medicare, which covers the elderly and disabled, acts as the primary coverage and Medicaid, which is for low-income Americans, functions as the secondary insurance.

Under the terms of the civil settlement, WellStar, which has five hospitals in Cobb, Douglas and Paulding counties, denied any wrongdoing, but agreed to pay the Georgia Department of Community Health $2.72 million and an additional $10,000 to cover costs associated with the investigation.

"Active enforcement and oversight are the keys to ensuring that Georgia taxpayers are not overpaying for Medicaid services, which is critical at all times but especially when demand for Medicaid services is so high and public monies to pay for Medicaid are scarcer than ever," Baker said in a statement.

According to the AG's Office, "WellStar cooperated fully with the state's investigation and implemented corrective actions to ensure that similar billing problems do not reoccur."

Jim Budzinski, the health system's chief financial officer who was also abruptly appointed as acting president Thursday night, said the overpayments from Medicaid date back four years. He said the health system repaid the Medicaid system, dollar for dollar, on Monday.

He said every time the health system notices that it has been overpaid, "We immediately try to return funds."

However, with the four years of overpayments WellStar received from Medicaid, "our system was inadequate" in spotting them, Budzinski said.

"So we hired outside auditors and worked with the state," he said. "Auditors found no other issues to any other payers. We have implemented other measures to more accurately evaluate payments from the state."

The Georgia Medicaid Fraud Control Unit and the Department of Community Health conducted the investigation.

"Reviews of other hospitals for similar billing issues are on-going and any identified will be referred to the Fraud Unit for further investigation," DCH Inspector General Robert Finlayson said.

WellStar spokesman Keith Bowermaster said the settlement was unrelated to WellStar's board of trustees' surprise move late Thursday to fire the health care provider's president and CEO, Dr. Greg Simone.

It remains unknown why Simone was terminated, effective immediately. The vote was unanimous with the exception of two board members, who are physicians employed by the health system.

Simone did not return calls for comment Friday.

Randall Bentley, chairman of the 18-member board of trustees, said Thursday, "It was just time for a change." Budzinski was appointed acting president and CEO while the board prepares for a national search for Simone's replacement, Bentley said.

Bonnie Wilson, WellStar's executive vice president and general counsel, received notice earlier this week that her employment agreement will not be renewed either.
Comments
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wellstar doc
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September 25, 2010
Simone was a sleazy, third rate,unethical ceo who was poorly respected by anyone with any insight.Good riddance
Public Servant
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September 13, 2010
Only 100,000 a year for your over worked, long suffering husband? How HORRIBLE. And yet, there are law enforcement and fire fighters who put there life on the line each and everyday for FAR, FAR less than 100,000. In fact, you probably could not buy your designer clothes and high end car for what they make. 30 patients a day??? OMG!! I bet he doesn't work 2 or 3 jobs to make ends meet! Oh, he went to college. SO DID I! Masters degree. Guess what. Working 2 jobs to make ends meet. Give me a break! I have no tears for your 100,000 a year. Poor you. Hope you don't have to give up that $150 hair cut!
wellstar rn
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September 13, 2010
As a nurse at a Wellstar facility, I am completely disgusted by all that is coming to light about Wellstar's "leadership". The public should know that the majority of employees at Wellstar (the underpaid ones) really DO care about patient safety & welfare, and do their best to provide excellent care. Unfortunately, we are often hindered by corporate's desire to save money at the expense of patients and employees. So Simone gets a 2 million dollar 'severance' package reward for stealing and lying??? I got a 40 cent raise for my hard work this year. I hope that criminal charges are eventually brought against those who have acted so despicably (sounds like the list is growing)!!!
think again
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September 11, 2010
Please understand once Wellstar buys up all the physicians in Cobb,Douglas, and Paulding counties the consumer will have no choice, Wellstar will have no competition,which usually means no accountability,poor service,and high costs.Wake up!! It is already happening.I am convinced that if we had other hospitals in these counties Wellsar and their huckster Simone could not have allowed their hospitals to down the crapper
anonymous
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September 11, 2010
I believe that there are a LOT of confused souls out there in MDJ land! The intent to "buy up" the physicians in WellStar has been a goal for not only WellStar, but the physicians themselves. I believe that it has been a very wise decision to do this "early" in this healthcare game. As the government has changed the healthcare pricing/funding/availability, it is in the best interest of the physicians to locate themselves where they are part of a hospital or healthcare organization. As one would research "Bundle Payment" projects and research being conducted across the country, one would realize that physicians as part of a larger "bundle" payment will be more valuable than remaining on their own. Research it and then talk about how "dishonest" this is. To me....it's just smart!!
Moreofthesame99
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September 11, 2010
My husband was a wellstar physician. They screwed him out of his salary and even cut it over two years by 25% because he didn't meet their artificial "performance" budgets. At one point he was earning less than $100k for seeing over 30 patients a day!!!! The fact that wellstar management did NOTHING to help him and employed incompetent managers was of no consequence: Who paid for this? Physicians like my husband and patients who received shortened face time.

Wellstar sucks! Check their 10k filings and see how much the top management earn! It's disgusting!!!

And shame on the county politicians who pander to them!
anonymous
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September 11, 2010
Please do not confuse the intentions and hard-working WellStar employees' mission with one, single man. I believe that there are 11,000 employees who want to provide the BEST, "world class" healthcare to our communities and continue to plan to do just that. The intentions and actions of one man should not cloud the overall goal of a great healthcare system!! I HAVE been treated at several hospitals in and around the Atlanta area and have chosen to go to WellStar. Again, please do not confuse the goal of every GOOD community healthcare system with what one man can, or cannot, do for a system. Dr. Simone has been a great physician and leader and he and his family deserve respect for their privacy. There were NO patients harmed in his termination and there certainly will not be!! It is NOT ANYONE's business. It is the business of the Board of Trustees and I appreciate them remaining confidential in this matter. The Board of Trustees is exactly that.......the trusted leaders of this organization!!
concerned citizen 2
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September 08, 2010
I too am an employee at Kennestone Hospital.I am much less concerned about the privacy of Dr Simone than I am of the health and integrity of our PUBLIC community hospitals that he may have disgraced.The rumors regarding his firing can easily be put to rest by full disclosure and transparency regarding the circumstances that resulted in his dismissal.This is not about protecting Dr Simone and his family,I have no concern for them at this time nor should a resposible board
concerned citizen
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September 07, 2010
I am an employee of Wellstar Kennestone and have been for almost 30 years. I just want to say that Dr.Simone deserves some respect and privacy during this time as it is clear this was not his choice to leave. So how about a little respect and kindness to him and his family... We do not know what happend so if you do not know keep your thoughts to yourself.
blowwindblow
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September 05, 2010
The recent Medicaid issue had nothing to do with coding.

If you have questions about the coding at Kennestone or any other WellStar hospital, please bring them to the attention of leadership.

Perhaps the Compliance dept. can help out too.

staff12
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September 05, 2010
Wellstar better wake up. You are losing honest, caring, QUALIFIED staff and hiring poorly trained uncaring people to replace them. Dr. Simone is only part of the problem. As long as Wellstar continues to care more about the bottom line than their patients and staff, trouble will continue to haunt them. Shame on you Wellstar, shame on you.
whistleblower
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September 05, 2010
I am a longtime wellstar employee at kennestone hospital,and for years colleagues have questioned some of the practices regarding billing and coding of various diseases in which the hospital engages.There exist many opportunities for whistleblowers in such a corruptly managed organization
cobb citizen
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September 05, 2010
The amount of negative commentary that seems to exist regarding Wellstar and Dr Simone is quite eye opening.It would serve the public,as well as wellstar if all the facts regarding Dr Simone's dismissal were revealed in an honest and fully transparent fashion.Furthermore the taxpaying public deserve details regarding all physician practice purchase transactions.It would appear from the blogs that in order for Wellstar as a private management company to restore the public's confidence, and indeed for this company to even survive full and complete disclosure regarding their business activity is essential.
Osamabndrinkin
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September 05, 2010
The government doesn't care about the ill deeds of wellstar because wellstar buys the government. They made sure they didn't have to worry about antitrust. They even bought this newspaper: a copy is on every ward. Simone personally got $8m from "sale" of his practice plus his salary did not include non-public bonuses. Enron beats wellstar on ethics every time. And where do they get this money? Off every small business having to pay higher health premiums because wellstar care is 40% higher than others in metro Atlanta. Off the indigent whose houses are taken for "medical" bills at full price! Jail to Simone Greed and his lover!!!!
MedCobb
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September 05, 2010
Let's remember that Dr. Lipson started Wellstar down the path to buying up practices, making promises that weren't kept and treating the non-Wellstar owned practices with less than a congenial attitude. Dr. Simone continued the practice. Hopefully, Randall Bentley will bring this group back to reality with respect and equality for all medical practices at Wellstar facilities.
wellstar employee
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September 05, 2010
Doesn't surprise most employees that Wellstar was cheating and defrauding Medicaire/Medicaid they have been screwing the tax paying citizens of Cobb,andDouglas,andPaulding ever since Dr Simone was named CEO.
WELLSTAR RN
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September 04, 2010
Under Dr Simone Wellstar has forced the RNs to nurse the papers and not have time/staff to nurse the patients. I sincerely hope under new management the RN staff will be adequate to give "world-class" healthcare.
oh yeah!
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September 04, 2010
no such thing as patient choice @ Wellstar. They automatically streamline all their home health and hospice referrals to WELLSTAR HOME HEALTH and WELLSTAR HOSPICE. My neighbor's husband was sent to their inpatient Hospice Facility in Austell when they lived approximately 10 minutes from an inpatient hospice unit in Cartersville.....you figure it out!
WELLSTAR staff physi
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September 04, 2010
Dr Simone was a ruthless,dishonest CEO without integrity and deserved to be fired long ago.A significant number of the non Wellstar physicians which comprise greater than 50% of practicing physicians in Cobb,Douglas,and Paulding counties mantained little respect for Dr Simone and his predatory, and intimidating actions.This represents a great opportunity for Wellstar to put aside the threatening,petty,simpleminded,visionless management of Dr Simone
cobb citizen
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September 04, 2010
If wellstar is so well respected why do as many as 25% of cobb residents,according to wellstar's own statistics seek health care outside the wellstar system at piedmont,northside,and emory?
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