Since the formation of the False Claims Act (FCA) allegations of healthcare fraud and abuse have consistently grabbed the headlines. In 2017 alone, The U.S. Department of Health and Human Services (HHS) made approximately $90 billion in improper payments to Medicaid and Medicare programs. For healthcare providers, navigating this challenging and oftentimes confusing set of reimbursement guidelines have commonly led to the rate of billing errors rising above 30 percent. From telehealth services conducted at non-rural originating sites, to the widespread distribution of medically unnecessary drugs, including opioids, the allegations of healthcare fraud and abuse by government entities and private payers are more prevalent and diverse than ever before.
DEFENSE COSTS OF ACTUAL OR ALLEGED BILLINGS ERROR
Anyone with a national provider identification number is susceptible to a physical or electronic data mining audit. Allegations of improper billings by CMS can range from a lack of medical necessity, to incorrect coding and even insufficient documentation. Our policy provides defence in respect of these allegations utilizing reputable and experienced claims managers.
SHADOW AUDIT EXPENSES
Appeals against violations can be a long and costly process, often stretching over two years if they reach a Federal Court. Our policy provides coverage for the expenses arising out of an independent audit on your billing practices following allegations of fraud by a government entity or private payer.
REGULATORY FINES AND PENALTIES
Our policy offers reimbursement for fines and penalties arising out of a range of medical regulatory violations including HIPAA-related fines and penalties, Stark law (triggered by physician referrals), EMTALA (ensuring public access to emergency services regardless of ability to pay) and Federal False Claims and Social Security Acts.
CYBER AND PRIVACY
Our cyber and privacy insuring clauses have been tailored to address healthcare companies’ specific cyber exposures. Our policy includes specific references to HIPAA and HiTECH legislation, and offers a separate section for extortion to address the growing threat of ransomware. As well as incident response service with a NIL deductible, we also offer risk management training courses to all insureds.