Tennessee Doctor Loses Medicare Reimbursement Privileges Over $670 in Billing Errors

A West Tennessee doctor has lost his Medicare reimbursement privileges over $670 in billing errors, and the consequences are devastating for his practice and the rural community he serves.

“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 30 counts of wrongful Medicare billings over the course of 20 months,” the McKenzie Banner, located in rural Carroll County, reported last week:

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 were filed correctly 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 counts are the result of clerical errors made by others, not Dr. Merrick directly.

The penalty of these infractions is suspending Dr. Merrick’s Medicare billing privileges for at least three years. Meaning, he has a medical license and can see patients but no longer those covered by Medicare.

What You Need to Know:
Dr. Merrick still has a medical license.
According to Dr. Merrick, MMC plans to remain open.
10 people may lose their jobs.
All infractions are clerical errors.
Dr. Merrick didn’t receive money from alleged claims.

“This is the worst big government abuse of an individual I’ve seen ,” former State Senator Roy Herron, a Democrat who represented the 24th State Senate District and a personal friend of Dr. Merrick, tells The Tennessee Star.

“Many of my Republican friends told me that if I voted for Hillary Clinton I would see a huge growth in the interventions of big government on the rights of the individual and small businesses, and they were right!” Herron adds.

Herron noted that his friend is a “family doctor about to lose his profession.”

“And his patients are about to lose their beloved physician of 30 years because the federal bureaucracy cannot tell the difference between fraud and clerical errors occurring in less than 1 in a 1,000 billings,” he says:

Literally 30 billings on a total of 10 patients out of more than 30,000 billings! Eg, a clerk billing on the wrong one of 2 patients the doctor had seen with identical names.

In each case, the care was given, the mistake was clerical, and not a dollar was wrongfully paid.

And if the $670 total had been paid over the 20 months, it’d have amounted to about a dollar a day. Likely a MD would throw away his life for a dollar a day?

But try getting Big Government to look at the facts, use common sense, and do a citizen right!

The Tennessee Star has reviewed the key documents in the case and can confirm that the federal government’s charges against Merrick seem to be weak.

The bad news began for Dr. Merrick when he received a letter dated March 17 from the Centers for Medicaid and Medicare Services (CMS) telling him that his Medicare billing privileges were being revoked, effective April 16:

[pdf-embedder url=”https://tennesseestar.com/wp-content/uploads/2017/10/Notice-of-Revocation.pdf”]

Merrick hired an attorney from a high powered Nashville law firm who specializes in health care law and filed a request for a review of the findings by someone “independent” of the original determination on May 11, within the 60 day time frame allowed for such an appeal.

The letter requesting that review contained a host of exculpatory evidence. An excerpt from that letter can be seen below:

While allegedly submitting claims for services provided to dead Medicare patients is, on its face, a problem, what actually occurred in each case was a simple billing mistake that does not warrant the action that CMS has taken. Specifically, the 30 claims fall into three (3) categories:

• Fifteen (15) claims involved a billing employee of MMC inadvertently identifying a deceased patient (e.g., Joe M. Smith) in the billing system with an identical or similar name to the living patient (e.g., Joe G. Smith) who had actually received the services when preparing the claim;

• Three (3) claims involved a situation in which I inadvertently provided the name of a recently deceased nursing home patient to a billing employee of McKenzie Medical Center PC in a handwritten medical record; and

• Twelve (12) claims involved non-face-to-face chronic care management services (essentially a review of medical records) actually provided with respect to patients whom neither McKenzie Medical Center PC nor I knew were deceased on the date of service or the billing date.

In short, what occurred were inadvertent errors in the submission of 30 claims out of countless correct claims submitted in my name over the same period. No fraud or improper intent has been alleged by CMS, and in fact none existed. Importantly, the claims at issue, which would have generated no more than a few hundred dollars in aggregate reimbursement, represent an infinitesimally small percentage (less than one-tenth of one percent (< 0.1%) of the total number of Medicare claims submitted by MMC for services provided by me during the relevant period. Further, payment was denied for all of the claims at issue, meaning that there was no risk or harm to the Medicare program.

On August 9, however, that independent review denied Dr. Merrick’s review without providing any substantive response to the points made by him in his May 11 letter.

Though Dr. Merrick’s Medicare billing privileges have been at least temporarily revoked for the next three years, he still has three additional levels of appeal available to correct the problem caused by this relatively minor billing issue.

Meanwhile, he will not be able to receive reimbursement for any medical services provided to patients on Medicare, which will represent a significant loss of revenue to himself personally and to the McKenzie Medical Center which he owns.

Herron says that Dr. Merrick has reached out for assistance in resolving the situation to Rep. David Kustoff (R-TN-08) who represents him in Congress, and Senator Lamar Alexander (R-TN), but neither have responded so far.

In 2010 Herron was the Democratic nominee in the 8th Congressional District in Tennessee, but was defeated by former Rep. Stephen Fincher, a Republican. He served as chairman of the Tennessee Democratic Party from 2013 to 2015.

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