The hospital business in Georgia’s second-largest city is dealing with a double dose of financial misery.
The first round of bad news centered on Columbus Regional Health. State Attorney General Sam Olens last week announced that Columbus Regional and related entities had agreed to pay the state and federal government up to $35 million to resolve allegations of false Medicaid claims.
Then the Columbus Ledger-Enquirer reported Saturday that St. Francis, another big nonprofit hospital organization, has been told by the feds it must repay $21.4 million and change the way it does business. That came 10 months after St. Francis said it could not account for about $30 million on its financial books.
The two situations, while unrelated, could force large payouts by two big economic drivers in west Georgia and east Alabama.
“I can’t recall anything like this happening in the past,” state Sen. Joshua McKoon, a Columbus Republican, said Tuesday. McKoon added that he expects both hospitals to survive.
The Columbus Health settlement resolves allegations that the defendants submitted claims for services billed at higher levels than supported by documentation; for radiation therapy that did not qualify as such; and for claims submitted in violation of Medicaid rules prohibiting payment in return for patient referrals.
NPR reported last week that White House budget director Shaun Donovan called for a “more aggressive strategy” to thwart improper government payments to doctors, hospitals and insurers in a previously undisclosed letter to U.S. Health and Human Services Secretary Sylvia Burwell earlier this year.
Government health care programs covering millions of Americans waste billions of tax dollars every year through these improper payments, Donovan said in the Feb. 26 letter.
In the Columbus Regional case, Olens said Georgia also reached a civil resolution with Dr. Andrew Pippas, a medical oncologist who agreed to pay Georgia and the feds $425,000. That settled allegations he received improper salary and medical directorship payments from Columbus Regional, resulting in the illegal submission of claims to Medicare and Medicaid.
“Cancer patients are among those most in need of a doctor’s earnest and unbiased medical advice,” Olens said. “Medical providers must ensure that they do not solicit, offer, or accept payments based on their referral of patients.”
McKoon called Pippas ” a real leader in our community,” adding, “I’m very comfortable saying Dr. Pippas is extremely honest.”
The St. Francis situation comes as the hospital is in talks to be acquired by Tennessee-based LifePoint Health.
A federal audit said St. Francis Hospital management did not comply with regulations and a regulatory agreement connected to the financing of its $252 million expansion and campus renovation, completed in 2013, the Ledger-Enquirer reported.
Originally terming the $30 million financial hole an “accounting inaccuracy,” St. Francis disclosed that its finance chief had been “permanently relieved of his duties’’ in November. Other fallout included 80 job cuts, the newspaper reported, and talks with potential buyers or investors. CEO Robert Granger resigned in early March.
LifePoint told the Ledger-Enquirer that the payout issue at St. Francis will not derail the company’s plan to acquire the hospital.
This article was done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Andy Miller is CEO and editor of Georgia Health News.
