Medicare Dispute Forces Town to Mobilize and Save Doc: Part I

CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months.

As they would react to a flood, ice storm, or fire, local officials and residents in the rural town of McKenzie, Tenn. are rolling up their sleeves and taking on a force that threatens the loss of jobs and closure of its medical center, which serves a Medicare population dependent on its services to address their healthcare needs.

This is a town where everyone celebrates Veterans Day and the entire population turns out for Christmas parades with floats of tractors, trucks, and vintage autos. When you think of “flyover” towns such as McKenzie, it’s clear why they are robust in their efforts to get involved in a dispute that has pitted their rural doctor against the monolithic federal government, for which they share a general distaste.

What’s at risk is the McKenzie Medical Center, which employs 280 residents, making it the largest employer in the town of 5,300. Also at risk are McKenzie’s elderly, making up approximately 11 percent of the town’s population – and who, up until recently, have depended on the town’s only doctor to monitor their meds and keep them stable. He’s the town’s only internist and the only one who can read an echocardiogram – making for an alarming situation, given McKenzie’s aging Medicare population.

McKenzie’s Bryan Merrick, 65, a physician at the aforementioned McKenzie Medical Center who has been practicing medicine for more than three decades, recently had his Medicare billing privileges pulled by the Centers for Medicare & Medicaid Services (CMS) due to what have been described as simple clerical errors.  

Dr. Merrick has said that CMS revoked his Medicare billing privileges for three years back in April. He claims he was dropped from the Medicare program because he billed Medicare for 10 patients he didn’t see.

However, he argues that the billing mistakes were errors. For example, he said in one case, a staff member mixed up two patients with similar names.

“I didn’t do anything personally wrong, professionally wrong, or unethical,” Dr. Merrick told WBBJ.

He said CMS is questioning a total of $670 in services billed over a 20-month period. The federal government reviewed 30,000 claims submitted by Dr. Merrick, and only 30 billings for 10 patients were identified as improper, less than one-tenth of 1 percent.

Dr. Merrick appealed the CMS decision, but his appeal was denied in August. He plans to take his case before an administrative law judge (ALJ), but there is not a set timeline for that process, according to The Jackson Sun. He has also enlisted the help of former Tennessee State Sen. Roy Herron, an attorney for Dr. Merrick who is asking U.S. Rep. David Kustoff (R-Tenn.) and U.S. Sen. Lamar Alexander (R-Tenn.) to review the case.

“The local hospital has lost its only internist and the local nursing home has lost its medical director,” Herron said. “The medically underserved region is in danger of being even more desperately underserved. And thousands of patients will soon be at risk when they are without their long-time physician.”

During a recent Monitor Mondays Internet radio broadcast, Herron, a program guest, told listeners that because Merrick lost his Medicare privileges, other payers, including Tennessee’s Medicaid program, will also revoke his billing privileges. And private insurance carriers likely will follow.

“The McKenzie (Regional) hospital now has lost its only internist,” Herron said. “The McKenzie nursing home has lost its medical director.”

According to Herron, the inability of Merrick to practice will also impact those who depend on Merrick as an employer. Other healthcare professionals are expected to lose their jobs.

Furthermore, Carroll County is federally designated as a primary care Health Professional Shortage Area as well as a Medically Underserved Area. 

“The loss of Dr. Merrick’s services will hurt many people in this area,” Herron warned during the broadcast. “Some will die, needlessly and wrongfully killed by their – and our – federal government.”

Herron explained that CMS issued a statement accompanying the enactment of its revocation rules and assured providers that its revocation authority would not be used for “isolated occurrences or accidental billing errors.” Instead, revocations were to be directed at providers engaging in a “pattern of improperly billing” and “whose motive and billing practices are questionable, at best, and at worst, of a sort that might prompt an aggressive response from the law enforcement community.” 

So last week, Herron, an Eagle Scout, called an emergency meeting of local officials to ask Rep. Kustoff to lobby federal officials on behalf of the doctor as well as his patients. In a show of solidarity, Herron invited four mayors in Carroll County, along with McKenzie Mayor Jill Holland (pictured left). 

Also attending the meeting was Walter Butler, president of Bethel University, located in McKenzie, and the first IBM Thinkpad University in Tennessee. Merrick and his wife and four children, together with his partner, Dr. Volker Winkler, also attended the meeting.

In speaking on behalf of the other mayors, Holland, according to a meeting report obtained by RACmonitor, said that she and the others would not be there if they thought Merrick had done anything wrong. 

“He is the most trusted and well-respected doctor in our community,” Holland said. “For many patients, he is their lifeline. Without him, it is a death sentence.”

Holland reportedly told Rep. Kustoff at the meeting that he was their best hope. She told the congressman that he was their voice. “This is our plea to please help us,” Holland told the congressman.

While at the meeting, Merrick told the congressman of studies that purportedly claim that interrupting the continuity of care for senior citizens increases both hospitalizations and deaths.

Although Kustoff offered to try to get a quicker ALJ hearing for Merrick’s appeal, Merrick told the congressman that his case needed to go the top administrator of CMS.

Winkler told Kustoff that the McKenzie Medical Center couldn’t wait months or years for an ALJ, pointing out that the facility already has not been paid for any of Dr. Merrick’s services to Medicare patients for the past six months. Holland pointed out that elderly patients about to lose their doctor do not have months or years to wait.

In an interview with RACmonitor, Holland, whose mother is also a patient of Dr. Merrick, said that her mother (and Merrick’s other Medicare patients) received a letter from Merrick stating that he would no longer be able to treat them anymore, as he was not being reimbursed by Medicare.

“And the problem there is that these are elderly people we’re talking about,” Holland told RACmonitor. “Many of them will not get another doctor. My own mother has said she’s not getting another doctor. She’s going to continue to see Dr. Merrick, and she’ll have to pay out of pocket, but how many of these people … see their doctor once or twice a month, at least to monitor, depending on the different medications their blood and lab tests?”

Holland said the outcome will be that the health of these patients will diminish.

“These people will die,” Holland said. “Honestly, it’s a death sentence. He (Merrick) is their lifeline to good health, and many of them will not see another doctor. And he’s the only doctor I know that will give his cell phone number to patients. He will do house calls.”

Holland said the current situation with Merrick is already causing a lot of stress among the elderly.

“Their health will deteriorate,” Holland said, “as a result of not being able to see their primary care physician.”

“For a small, rural community, where 5,300 people (live) in our corporate city limits, and when you expand it to our ZIP code you’re looking at 9,000 or 10,000 people in the surrounding communities, he (Merrick) is the only one of two internists in the county. He’s the only one in McKenzie who (can) read echocardiograms,” Holland explained, “and the majority of (his elderly patients) have some sort of heart problems.”

Holland said it’s a tragedy that she’s been told that an ALJ hearing and possible appeal could take up to a year.

“These people don’t have a year,” Holland said. “They don’t have a month.”

“Sometimes, I think we’re just one small tiny rural town that is looked at (in a sense) that we don’t matter, when you look at the big scope, the big picture,” Holland said. “But it’s all of us – these little towns – that make up the heart of America, and that’s what suffers here, because big government has unbendable rules.”

When things happen like this in small communities, everyone knows word travels fast.

“People have been writing letters (and) they’ve been calling legislators,” Holland explained. “This is talked about in churches. If this were in a big city, I think nobody would blink an eye (to help), but here they realize that (Merrick is) their lifeline, and without him they could die. We need help here.”

CORRECTION: This story has been updated. The population of McKenzie is 5,300