Medicare Archives - Page 2 of 2 - Tennessee Star

Rep. Green Introduces Bill to Give Rural Hospitals More Flexibility

May 24, 2019May 23, 2019 Jason M. Reynolds

U.S. Reps. Dr. Mark Green (R-TN-07) and Bennie Thompson (D-MS-02) on Thursday introduced a new bipartisan bill to boost rural hospitals, Green said in a press release. The Rural Health Care Access Act of 2019 would repeal what Green called an arcane rule – “the 35-mile rule” – that bars hospitals from pursuing a Critical Access Hospital (CAH) designation. Currently, a rural hospital must be at least 35 miles away from another hospital to receive the CAH designation. If passed into law, this bill would allow states to designate a facility as a CAH if it meets all the other requirements. Those requirements include: The hospital must have 25 or fewer acute care inpatient beds. Must provide 24/7 emergency care services. The average length of stay for acute care patients must be 96 hours or less. “Folks living outside cities must not be left without health care access,” Green said. “We need to act now to remove old, onerous federal regulations and update our laws so that rural communities get the care they need.” Thompson said, “Rural hospitals are an integral part of the rural healthcare system. We must make sure rural communities have the same access to health…

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Trump Administration Ends Unions ‘Skimming’ $100 Million a Year from Medicaid

May 6, 2019May 13, 2019 Admin

by Bethany Blankley A final rule change has been implemented by the Trump administration to ensure that Medicaid providers receive complete payments as required by law. The Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) released the Medicaid Provider Reassignment Regulation final rule that removes states from being able to divert portions of Medicaid provider payments to third parties – including unions – outside of the scope of what the statute allows. The final rule came after CMS considered more than 7,000 comments from the public, healthcare providers, unions, state agencies, and advocacy groups during the public comment period after the changes were proposed. “State Medicaid programs are responsible for ensuring that taxpayer dollars are dedicated to providing healthcare services for low-income, vulnerable Americans and are not diverted in ways that do not comply with federal law,” CMS Administrator Seema Verma said in a statement. “This final rule is intended to ensure that providers receive their complete payment, and that any circumstance where a state redirects part of a provider’s payment is clearly allowed under the law.” Section 1902(a)(32) of the Social Security Act generally prohibits states from making payments for…

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Jury Convicts Comprehensive Pain Specialists’ John Davis in $4M Medicare Kickback Scheme

April 8, 2019April 7, 2019 Jason M. Reynolds

A federal jury in Nashville found the former CEO of a closed Tennessee pain management company guilty for his alleged role in a $4 million Medicare claim kickback scheme, U.S. Attorney Don Cochran for the Middle District of Tennessee said in a press release. John Davis, 41, of Franklin, the former CEO of Comprehensive Pain Specialists (CPS) of Gallatin, was convicted of all counts including one count of conspiracy to defraud the United States and violate the Anti-Kickback Statute, and seven counts of violating the Anti-Kickback Statute, Cochran said. The scheme involved approximately $4 million in tainted durable medical equipment (DME) claims to Medicare. Meanwhile, Davis’ sentencing will be scheduled for later this year before U.S. District Judge William L. Campbell Jr., who presided over the trial, Cochran said. According to evidence presented at trial, Davis abused his position as CEO to arrange for referrals of Medicare DME orders to his co-conspirator Brenda Montgomery and her company, CCC Medical, in Camden, Cochran said. Evidence showed that Davis operated a shell company called ProMed Solutions (ProMed), which he had registered in the name of his wife. Despite having no involvement with ProMed and performing no work, Davis’ wife and ProMed received more…

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Federal Agency Approves Ohio Work Requirement for Medicaid

March 17, 2019March 16, 2019 Andrew Shirley

The Centers for Medicare and Medicaid Services approved Ohio’s work rules for “able-bodied” recipients of Medicare Friday. Obamacare included a requirement that all 50 states expand Medicare eligibility to cover every individual whose income was up to 133 percent of the poverty line by January 1, 2014. In 2012, in a 5-4 decision, the Supreme Court voted to uphold much of the law while ruling the Medicaid expansion requirement unconstitutional. They found that the federal government couldn’t force the states to expand Medicaid with the threat of withdrawing existing Medicaid funding. Instead, each state would have the option to voluntarily opt into the expansion or not. After months of deliberation, then-Ohio Governor John Kasich announced he would push to accept the expanded Medicaid in March of 2013. The once tea-party supported governor faced significant conservative pushback and criticism for accepting the expansion, most significantly for its high cost and potential government overreach. In 2017, Kasich added provisions to the Medicaid expansion, but stipulated that certain work requirements be met before “able-bodied” men could use the program. They had to work 20 hours a week, be actively looking for a job, receiving education or training, or engaged in community service. These measures, while supported in the state, received significant pushback from advocacy groups who…

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Three Doctors in Congress Diagnose the Problems with ‘Medicare for All’

March 12, 2019March 12, 2019 Admin

by Rob Bluey Few issues have animated conservatives as much as Obamacare. But there’s a new threat on the horizon. It’s called Medicare for All – and it would be a massive government takeover of your health care. The Daily Signal spoke with three medical doctors who are serving in the U.S. House – Reps. Scott DesJarlais (pictured, center), Paul Gosar (pictured, right), and Andy Harris (pictured, left) – to talk about Medicare for All and their solutions for a patient-centered alternative. Listen to the podcast or read the transcript below. Rob Bluey: I want to ask about not only some of the problems we find in health care today, but also solutions. Some of your colleagues on the left have put forward quite a radical proposal called Medicare for All. As doctors, I want to ask you to weigh in on what you think about it. Congressman Harris, would you like to begin? Rep. Andy Harris, R-Md.: The Medicare for All plan that was announced a couple weeks by my Democrat colleagues, over 100 of them, really will result in care for none. That’s the bottom line. The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out…

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Nine Years After Obamacare Passed, Agency Finds Numbers Were Wildly Off

February 26, 2019February 25, 2019 Admin

by Jarrett Stepman Democrats defeated Republicans in the Obamacare repeal fight by warning that 22 million Americans would be thrown off their health insurance. They pointed to data leaked from the Congressional Budget Office. Well, it turns out that data was completely wrong. According to a report by the Centers for Medicare and Medicaid Services released Wednesday, the Congressional Budget Office wildly overestimated the number of people who would lose their health insurance with the repeal of the individual mandate penalty. Initial estimates from the Congressional Budget Office said 14 million would drop off their health insurance coverage due to the elimination of the individual mandate. Then, during the height of the 2017 debate over repeal, progressives touted a leaked number from the Congressional Budget Office claiming that 22 million people would “lose” their insurance if Congress repealed the law. [ The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more ] However, as health care analyst Avik Roy pointed out, what made this number so high was the inflated number of people expected to lose their insurance due to repeal of the mandate – about 73 percent to…

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Missouri Federal Grand Jury Indicts 14 in Home Health Care Scam

December 29, 2018December 29, 2018 Anna Marie Bolton

A fraud scheme perpetrated on taxpayer-funded Medicare and Medicaid began to unravel with an anonymous tip alerting officials “that some Iraqis were fraudulently receiving home care services,” says a St. Louis Post-Dispatch report from earlier this month. Investigators examined billing records from several home health care companies that provide services to the elderly or infirmed. They then compared those to travel records for both the caregiver and the recipient of the care, finding that one or the other was out of the country at the time the care was allegedly provided. Two weeks ago, a federal grand jury indicted 14 involved in the $1.3 million fraud, reports the Post-Dispatch. The story was later picked up by a newsletter for the home health care industry. The 14 charged included employees of the agencies as well as clients, and they are: Kian Abdollah, 52 Mohammed Abdollah, 78 Dalia Ahmed, 27 Dena Ahmed, 30 Fatemeh Akbari, 73 Hala Alalewi, 38 Haider Albab, 75 Nouria Habeb, 67 Pegdah Heidari, 27 Tony Iyar, 57 Ghufran Abdallah Jaber, 51 Huda Mohammedjamil, 53 Hend Msallati, 33 Asal Yousif, 53 An investigation launched into one of the clients earlier this year began to shed light on the fraudulent activity. According…

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Incoming Members of Congress Want Medicare for All

November 11, 2018November 10, 2018 Admin

Ocasio

by Evie Fordham The House Medicare for All Caucus could count some new members when the 116th Congress convenes in January, although progressive candidates on the whole had a less than stellar performance on Election Day Tuesday. Democratic Rep.-elects Alexandria Ocasio-Cortez of New York and Deb Haaland of New Mexico and more winning progressive candidates campaigned on “Medicare for all.” The idea came to national attention because of Independent Vermont Sen. Bernie Sanders, who introduced a Medicare-for-all bill in Congress in September 2017, but there’s still no hard and fast definition of Medicare for all. Candidates like Ocasio Cortez and Haaland touted iterations of the proposed single-payer system that caused many critics to question how it would be funded. “People often say, like, ‘how are you going to pay for it?’ And I find the question so puzzling, because, how do you pay for something that’s more affordable?” Ocasio-Cortez said during an interview Nov. 1. [RELATED: FDA To Ban In-Store Sales Of Many Flavored E-Cigarettes To Keep Them Away From Teens] I believe in Medicare for all. Access to quality and affordable healthcare is a right, one that too many of our fellow North Texans have been denied for too…

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Dr. Mark Green Commentary: Liability Reform a Major Area for Healthcare Savings

October 30, 2018October 30, 2018 Admin

by State Senator Dr. Mark Green (R-Clarksville) In my third and final op-ed on the healthcare crisis facing America, I’ll discuss the last major problem causing the crisis as well as a solution to address it. You can read part one here, and part two here. Liability reform is a major area for saving billions of dollars. No one wants to be sued, causing doctors to go crazy ordering CAT scans and labs to make certain that if we are called to the witness stand, we can say we did everything we could. Frivolous lawsuits and exorbitant awards are costing providers and their insurance companies millions of dollars in insurance premiums. Those costs are then passed onto the patients in increased healthcare costs, and thus, increased insurance premiums. In some states, like Florida, three lawsuits and you lose your license. In a recent poll of emergency physicians, 65% said that they could save over $500 per 8-hour shift by decreasing unnecessary tests as a part of their defensive practice. Another 16% felt they could save between $200 and $500 dollars. I ran a level 2 trauma center that saw 75,000 patients a year. If we assume a conservative savings…

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Dr. Mark Green Commentary: ‘Cost Shifting’ Is a Major Contributor to the Healthcare Crisis Today

October 16, 2018October 15, 2018 Admin

Mark Green FRC endorsement

by State Senator Dr. Mark Green (R-Clarksville) The healthcare crisis in America is rightly one of the top issues on voters’ minds this election cycle. Unfortunately, missing from all the political rhetoric from most candidates is what is actually causing it. This is my second article in a three-part series where I seek to address the root cause of the crisis. You can read the first part here. In addition to having the wrong incentives, the second problem affecting our healthcare system is the effect on health insurance and other payers when government sets the price so low. When Medicare and Medicaid say they will only pay X for this procedure, and X is substantially below the market equilibrium price, one of two things happens: Either providers stop supplying that service at the set price, or they increase the price charged to others–a process called cost shifting. The effect of cost shifting has devastated the health insurance industry. As the government pays less, physicians and hospitals raise the price for others, which leads to increased cost of care for those with health insurance. This increase is then in turn passed to their customers in increased cost. As the cost…

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Letter to the Editor: The Way to Lower Healthcare Costs Is to Support and Elect Candidates Who Will Apply Free Market Principles

October 5, 2018October 3, 2018 Admin

doc nurse senior patient

Dear Tennessee Star, During the U.S. Senate debate I was glad to see Congressman Marsha Blackburn speak out against single payer healthcare. Being in the healthcare industry professionally since 1980 and now as a health consultant focused on health care legislation and helping companies and individuals navigate health care costs, pricing and affordability and keeping legislators informed from the provider perspective of the hindrances to care as a result of government intrusion – I know that single payer health care has disastrous implications. Obamacare has taken us in the wrong direction since 2010 – limiting access to plans, skyrocketing double digit cost increases each year, a diminishing individual marketplace, disappearing insurance plans and greatly reducing provider choice – it has been in direct contradiction to the two promises given to the American Healthcare consumer – If you like your doctor, you can keep your doctor, and it will reduce the costs to consumers. It is unfortunate that many mainstream Democrats are taking a bad idea and setting the stage to make matters much worse. Now many Democrats support Senator Bernie Sanders’ proposal to nationalize our health care system via single payer – also known as “Medicare for All.” In reality,…

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Bredesen’s Socialized Healthcare Plan Endangers Insurance, Medicare, Ad Says

September 28, 2018September 27, 2018 Jason M. Reynolds

Senate Leadership Fund on Tuesday launched a new advertising campaign discussing U.S. Senate candidate Phil Bredesen’s support of single-payer health care, saying it “threatens our healthcare.” The $1.2 million buy will run statewide on a combination of broadcast and cable television, radio and digital. It is available to watch here. Bredesen, a former Tennessee governor, is running for the Senate seat being vacated by U.S. Senator Bob Corker (R-TN). His opponent is U.S. Representative Marsha Blackburn (R-TN-07). “Multimillionaire Phil Bredesen is dropping a fortune on ads portraying himself as a moderate, but his plan for a government takeover of health care would give Bernie Sanders palpitations,” said Senate Leadership Fund Spokesman Chris Pack. “Bredesen just isn’t the moderate he wants Tennessee voters to believe he is.” The ad brings attention to Bredesen’s book, “Fresh Medicine,” calling for socialized healthcare. The ad points out “Even the liberal Los Angeles Times called it ‘radical stuff,’” referring to a March 3, 2011 book review by David Lazarus for the newspaper. Also, the ad says Bredesen’s plan would eliminate employer-sponsored health insurance, “making you dependent on the government.” The plan would eliminate Medicare “as we know it, jeopardizing seniors’ care.” The ad ends with this…

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Republican Dave Joyce Releases Bizarre Campaign Ad Distancing Himself from Trump

August 31, 2018August 31, 2018 Anthony Gockowski

David Joyce

In a risky political move, Rep. Dave Joyce recently tried to distance himself from President Trump in a congressional district that the president won by 12 percentage points in the 2016 Election. Joyce, who is seeking reelection in Ohio’s 14th Congressional District, recently released an ad in which he touts his vote against repealing the Affordable Care Act. “When Republican leaders in Congress tried to take away protections for pre-existing conditions, I said no,” Joyce states. “I won the the fight to fund the Great Lakes restoration, and when President Trump tried to take it away, I said no again.” “I’m Dave Joyce, and I approve this message, because I’ll do what’s right for northeastern Ohio, even if it means standing up to my own party,” the ad concludes. Joyce, however, regularly voted to repeal Obamacare before Trump took office, and his campaign website used to tout a record of voting for repeal more than 30 times, Cleveland.com reports. In a state that Trump won by by 8 points, the ad seems out of place, leaving Joyce’s spokesman, Dino DiSanto to explain that “Joyce will do what is right for his district, no ifs and or buts—doesn’t matter party affiliation…

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How Medicare’s Private Plans Surpass the Traditional Program

August 8, 2018August 7, 2018 Admin

doc nurse senior patient

by Dr. Kevin Pham and Robert E. Moffit Medicare Advantage, a system of competing private health plans, is surpassing the traditional Medicare fee-for-service program in delivering high quality, cost-effective medical care for senior and disabled citizens. The prominent research firm Avalere recently published a major study showing that Medicare Advantage generally outperformed traditional Medicare. This was especially so in caring for the most challenging patients who suffer from chronic conditions and complicated medical problems. Major structural differences between traditional Medicare and Medicare Advantage largely account for the differences in performance. Traditional Medicare, enacted in 1965, pays doctors and other medical professionals on a fee-for-service basis, meaning that the government reimburses medical professionals a specific fee for every one of thousands of services provided to Medicare patients. After almost two futile decades of trying to control costs, in the 1980s Congress overhauled hospital and physician payment. In 1989, Congress created a new physician payment system in which the government would reimburse Medicare doctors based on a calculation of the putative value of individual medical services—including the resources and time required to provide them—and capping the payment. This bizarre reimbursement formula, plus subsequent payment updates, proved faulty. Medical stakeholders compromise the entire process because they also are involved in setting the prices of Medicare’s services and continuously fight to evaluate their own services higher, leading to questionable fee schedules, confusion, and inefficiency. For years, traditional Medicare’s payment system generated perverse incentives, allowing hospitals, for example, to overtreat their patients, delivering more care and more services, more reimbursements, and higher revenues. Congress created Medicare Advantage in 2003 as…

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President Trump Moves to Protect Home Care Workers from Union Shakedown

July 16, 2018July 15, 2018 Admin

senior citizen health care

By Richard McCarty The Centers for Medicare and Medicaid Services, a part of the U.S. Department of Health and Human Services, has proposed rolling back an Obama-Era regulation that allowed union dues to be deducted from Medicaid checks. If the proposed regulation takes effect, only deductions specifically allowed by law, such as court-ordered wage garnishments or child support payments, will be permissible. Of course, any caregivers who wish to join or stay in a union could still do so. They would just need to make arrangements to pay their dues, which could easily be done by authorizing the union to draft money from their bank account. For years, the Service Employees International Union (SEIU) has skimmed money off of Medicaid checks sent to in-home personal care workers. Many of these people care for relatives or friends and did not want to join a union. In Minnesota, 27,000 caregivers were unionized after an election in which fewer than 6,000 voted and SEIU received less than 3,600 votes. Unsurprisingly, some had no idea when the unionization election was being held and were surprised when they noticed that money had been deducted from their Medicaid checks without their authorization. Of course, SEIU does little for…

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Feds Freeze ‘Obamacare’ Payments; Premiums Likely to Rise

July 9, 2018July 8, 2018 Admin

Obamacare

The Trump administration said Saturday it’s freezing payments under an “Obamacare” program that protects insurers with sicker patients from financial losses, a move expected to add to premium increases next year. At stake are billions in payments to insurers with sicker customers. In a weekend announcement, the Centers for Medicare and Medicaid Services said the administration is acting because of conflicting court ruling in lawsuits filed by some smaller insurers who question whether they are being fairly treated under the program. Risk adjustment The so-called risk adjustment program takes payments from insurers with healthier customers and redistributes that money to companies with sicker enrollees. Payments for 2017 are $10.4 billion. No taxpayer subsidies are involved. The idea behind the program is to remove the financial incentive for insurers to cherry pick healthier customers. The government uses a similar approach with Medicare private insurance plans and the Medicare prescription drug benefit. Major insurer groups said Saturday the administration’s action interferes with a program that’s working well. The Blue Cross Blue Shield Association, whose members are a mainstay of Affordable Care Act coverage said it was “extremely disappointed” with the administration’s action. The Trump administration’s move “will significantly increase 2019 premiums for…

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Another Government-Run Website Is Failing, and It’s Not HealthCare.gov

June 2, 2018July 18, 2018 Admin

Medicare plan finder

by Joel White Another government website is shortchanging consumers with inaccurate information, enrollment details presented in confusing Washington-speak, the unavailability of human support, and no easy way to search for doctors covered under your plan. No, I’m not talking about HealthCare.gov—though its shortcomings are well-documented—but rather, its older, clumsier twin, the Medicare Plan Finder. We all remember the disastrous 2013 launch of Obamacare’s online portal, in which a grand total of six people enrolled in coverage on the first day, because the web tool was associated with a highly polarizing law that had been enacted three years earlier. Yet, when the Medicare Plan Finder—the federal government’s online tool to help Medicare beneficiaries and others obtain information about, and make decisions on, coverage options in fee-for-service and Medicare Parts C and D—launched at the height of the dot-com age, no one blinked. [ The liberal Left continue to push their radical agenda against American values. The good news is there is a solution. Find out more ] The dirty little secret is that the Medicare Plan Finder deserves the same stringent oversight HealthCare.gov received and more, because its shortcomings are even more far-reaching. For all the media hype and congressional handwringing, most Americans still bypass…

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Dr. Bryan Merrick Makes His Case To Top Federal Officials for Reinstatement into Medicare System

November 11, 2017November 10, 2017 Admin

Dr. Bryan Merrick and his attorney Roy Herron met in Baltimore on Thursday with top federal officials at the Centers for Medicare and Medicaid Services (CMS), the part of the Department of Health and Human Services responsible for administering the Medicare program, to make the case for the reinstatement of his Medicare billing privileges. As The Tennessee Star reported, the well respected West Tennessee family practice doctor’s Medicare billing privileges were revoked in March under an abusive Obama-era regulation over a reported $670 in billing errors. Late last month, Senator Lamar Alexander (R-TN) called on Senator Orrin Hatch (R-UT) to hold hearings at the Senate Finance Committee he chairs to consider revoking the regulation. Earlier in October, McKenzie, Tennessee Mayor Jill Holland wrote a letter to Senator Alexander asking him to hold hearings of the Senate Health, Education, Labor, and Pensions Committee he chairs to consider revoking the regulation, but Alexander noted that Hatch’s Senate Finance Committee has jurisdiction over Medicare and Medicaid issues. Last week, former Congressional candidate Dr. George Flinn wrote President Trump a letter requesting that he instruct CMS to amend the regulation. “We had a good meeting. We felt like the officials listened carefully and asked…

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West Tennessee Doctor Dropped by Medicare a Caring Man Who Would Never Cheat the System, Supporters Say

October 17, 2017October 17, 2017 Wendy Wilson

Five years ago, Janice Lowery of West Tennessee moved to another town, which left her a greater distance away from the doctor she had been going to for more than a decade. But she wasn’t about to look for another doctor, even though it would not have been hard to find one near her new home. Instead, she has continued to see Dr. Bryan Merrick at the McKenzie Medical Center, driving an hour and a half one way to get there. Merrick is a caring doctor who doesn’t dash in and out of the room and make you feel like a number, Lowery said. “He listens to you,” she said. “You don’t feel rushed.” Lowery even drives her husband, who is legally blind, to see Merrick for separate appointments. Like many of Merrick’s patients, Lowery was alarmed this past spring when he was accused of Medicare fraud and lost his Medicare reimbursement privileges for three years. It’s a turn of events that many of his supporters consider an injustice, and they fault distant bureaucrats with not caring about their small rural community. Merrick, who is 62 and has been practicing medicine for more than 30 years, was found to have…

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Supporters of West Tennessee Doctor Frustrated With U.S. Rep. David Kustoff in Medicare Billing Case

October 15, 2017October 15, 2017 Wendy Wilson

Supporters of a beloved rural West Tennessee doctor they say is falsely accused of Medicare fraud are frustrated with the lack of response they are getting from U.S. Rep. David Kustoff (R-TN-8), whom they have turned to for help. Dr. Bryan Merrick of the McKenzie Medical Center lost his Medicare reimbursement privileges in April for three years over $670 in billing errors. Only 30 billings for 10 patients, less than one-tenth of 1 percent of 30,000 claims submitted, were identified as being incorrect in a review by the federal government. Merrick, who has been practicing for more than three decades, has maintained they were clerical errors. Jill Mayo, a registered nurse and the practice manager at McKenzie Medical Center, told The Tennessee Star on Friday that the practice reached out to Rep. Kustoff’s office in May. While his office has said Kustoff has been looking into the matter, he has not offered Merrick any concrete help or insight, according to Mayo. “Nothing has changed,” Mayo said. Kustoff’s office released a statement to The Star late Friday saying, “Congressman Kustoff is aware of Dr. Merrick’s situation, and our office has been in contact with CMS [Centers for Medicare and Medicaid Services] regarding the…

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