By Jason and Brittany Martin firstname.lastname@example.org
McKENZIE (October 4) — After an unblemished 31-year career in medicine a local doctor is faced with accusations of Medicare billing fraud. On April 16, the Center for Medicare and Medicaid Services (CMS) accused Dr. Bryan Merrick of wrongful Medicare billings on ten patients over the course of 20 months.
During the 20-month period in question, Dr. Merrick’s office filed approximately 30,000 Medicare claims for patients. The 30 claims account for less than one-tenth of 1% of all billings. In other words, 99.9% of the 30,000 billings are not in dispute and in accordance with CMS guidelines.
The estimated value of the wrongful billings is $670, which was never paid to Dr. Merrick or McKenzie Medical Center (MMC). All 30 claims are the result of clerical errors made by others, not Dr. Merrick.
The penalty of these infractions is suspending Dr. Merrick’s Medicare billing privileges for at least three years. Meaning, he has a valid medical license and can treat patients with private insurance or self-pay, and can participate in the treatment of Medicare patients as long as a nurse practitioner assists in the actual treatment.
Dr. Merrick, 62, would be retirement age by the time the three-year suspension is lifted. Currently, he is faced with pursuing a multi-level appeals process or the possibility of early retirement.
Dr. Merrick says McKenzie Medical Center will remain open. Other physicians, nurses and physician assistants are able to continue treating Medicare patients.
If Dr. Merrick is forced into early retirement, his support staff of ten employees might lose their jobs at MMC.
On August 9, CMS notified Dr. Merrick his appeal was reviewed and denied.
According to Dr. Merrick, CMS was dismissive of his defense and has refused to review the case until a much later date.
“I did not do anything personally or professionally unethical. These are honest mistakes made by people who I had no direct control over,” he said.
Dr. Merrick insists, “No harm was done to Medicare because no money was ever paid.”
CMS has a backlog of 607,402 cases under review in the United States. In Tennessee, four physicians face similar clerical infractions as Dr. Merrick. Medicare officials expect this backlog to grow to over 900,000 within four years.
The next course of action is to file an appeal with an administrative law judge who would not look at the case until three to four months later.
If that appeal is denied, Dr. Merrick can request a hearing with a three-person federal review board. This would also take three to four additional months.
The entire appeal process could take a year or more before all options are exhausted.
Since April, Dr. Merrick has followed the necessary steps of the appeal process. With his options waning, he’s now seeking assistance from elected federal officials to intervene.
“I serve as the medical director of the local nursing home and hospice. Carroll County (like nearly all of its surrounding counties) is a federally designated Health Professional Shortage Area for primary care, and I am one of only 13 primary care physicians in the county. Most importantly, however, I serve hundreds of patients who depend upon the medical care and compassion that I provide, and who would be devastated to not have access to me for their health care needs,” Dr. Merrick stated in a letter dated August 25 to Senator Lamar Alexander.
Dr. Merrick is known as a kind and compassionate physician who has been known to make house calls and give his cell phone number to patients in need. Staff members said Dr. Merrick is “always on call,” checking on his patients when he’s on vacation.
Dr. Merrick has offered years of pro-bono medical service during McKenzie football games to injured players on the field.
Dr. Merrick is one of two board certified internists in Carroll County, but the only internist for MMC and McKenzie Regional Hospital (MRH). He is one of three founders of MMC. MMC employs 30 health care providers, has 290 total employees, operates five rural clinic locations, and serves approximately 7,000 Medicare and 8,000 Medicaid patients.
It is the second largest employer in Carroll County. MMC is a member of the inaugural Tennessee patient-centered medical home initiative and had the second highest quality scores of all BlueCross BlueShield of Tennessee clinics in 2016. MMC is also a leading member of National ACO, an accountable care organization that saved Medicare over $3,000,000 in its most recent performance year.
CMS is a federal government entity that was established in 1977 and is part of the Department of Health and Human Services (HHS). CMS covers 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace.
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