CMS has accused Bryan Merrick, MD of wrongful Medicare billings on 10 patients over a span of 20 months. The town’s mayor asks for help from Washington.

Jill Holland, the mayor of the rural town of McKenzie, Tenn., population 5,300, is seeking the help of U.S. Sen. Lamar Alexander (R-Tenn.) in an unfolding drama pitting the town’s lone physician against Medicare.

Meanwhile, in McKenzie, the stakes are high, as previously reported by RACmonitor. The loss of Bryan Merrick, MD, 65, who has had his Medicare billing privileges yanked by Medicare over a billing dispute, threatens a loss of jobs and closure of a medical center that serves a largely rural and elderly population dependent on its services. Merrick, the town’s only internist and the only one who can read an echocardiogram, has been practicing medicine for more than three decades.

Last week, Mayor Holland wrote a letter to Sen. Alexander, chairman of the Senate’s Health, Education, Labor, and Pensions Committee, to hold a subcommittee hearing to consider the revocation of what the mayor calls “the egregious Obama-era regulation” that is now “jeopardizing the healthcare of … thousands of citizens in (and) around McKenzie.”

In her letter to Sen. Alexander, Holland cites a March 17, 2017 letter from the Centers for Medicare & Medicaid Services (CMS) revoking Merrick’s Medicare billing privileges based on what the mayor described as “(the) regulation’s vague standard.”

The mayor went on to describe the “pattern” cited in the CMS audit of Merrick and McKenzie Medical Center, the town’s largest employer with 280 employees. She stated that during the 20-month billing period in question, CMS found 30 incorrect billings for 10 patients, representing less than one-tenth of the 1 percent of 30,000 claims submitted on behalf of a number of providers, including Merrick.

“The clerical errors mixed up two patients with the same last name,” Holland wrote. “Five of the 10 patients involved a review of medical records for non-face-to-face chronic care management services for patients whom the McKenzie Medical Center did (not) know had died.”

Holland also quoted a CMS rule indicating that the agency has the authority to revoke a provider’s Medicare billing privileges – and, additionally, noting that CMS can “expand dramatically this revocation reason” if the agency determines that there has been a “pattern or practice of billing for services that do not meet Medicare requirements.”

“Now, the destructive fallout from that harmful rule has hit the residents of McKenzie, Tenn. and surrounding areas,” Holland concluded, “and our most esteemed physician is about to be forced out of the practice of medicine and no longer will be able to serve our people.”

McKenzie, part of Carroll County, Tenn., is federally designated as a primary care “Health Professional Shortage Area” as well as a “Medically Underserved Area.”

“This example has brought rural (healthcare) to the headlines again, but in this case, it has called the voices of patients to action to say ‘no more,’” wrote Janelle Ali-Dinar, PhD, a rural healthcare authority, in an email to RACmonitor. “Hopefully, the political representatives, the federal government, and CMS will recognize that rural (healthcare) already (is suffering from) great disparities and struggling to meet the needs of access and delivery – and that this narrative … (is) not where the focus should be, that is, creating equity of care, affordability, and access to rural patients.”

Ali-Dinar also cautioned against a rush to judgment, saying that the case represents “unchartered territory.”

“To unbundle it entirely to better understand the implications of potentially closing the rural medical center and the impact on the patients and other providers would mean the facts and perceptions would have to be completely aligned,” she wrote.

In a recent interview with RACmonitor, Holland said that Merrick is the most trusted and well-respected doctor in the community, saying that for many patients, he is their lifeline and that without him, CMS’s revocation is a death sentence.

In the meantime, the folks in McKenzie are waiting for a response from Sen. Alexander. Will he move forward with a subcommittee hearing to investigate the case?

Only time will tell.

UPDATE: In a story reported this week by the Tennessee Star, the newspaper has confirmed that Sen. Alexander has asked Sen. Orrin Hatch (R-Utah), chairman of the Senate Finance Committee, to conduct a hearing on the issue facing the embattled physician.

Program Note: Listen to Mayor Holland on Monitor Monday this coming Monday, Nov. 6, 10-10:30 a.m. ET. Register now

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