Medical Billing Errors Are On The Rise

Does Your Carrier Offer Medical Billing Coverage?

Not Many Carriers Can Offer You Coverage For Medical Billing.

We Have A New Market That Can AND Will Consider Accounts That Have Had Issues In The Past.

 

Healthcare Providers and Facilities that can be considered include:

Chiropractors, Dentists, Podiatrists, Medical Directors, Nurse Practitioners, Physicians and Most Healthcare Facilities

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 has commonly led to the rise of billing errors in excess of 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 can range from a lack of medical necessity, to incorrect coding, and even insufficient documentation. Our carrier’s policy provides defense 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 carrier’s 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 carrier 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

These insuring clauses have been tailored to address healthcare companies’ specific cyber exposures. They include specific references to HIPAA and HiTECH legislation, and they offer a separate section for extortion to address the growing threat of ransomware, as well as incident response service with a NIL deductible.

LIMITS, DEDUCTIBLES AND PREMIUMS 

Maximum limit————————- $5,000,000

Minimum Deductible ——————Nil

Minimum premium——————–$1,500

WHO’S IT FOR

  • Dialysis Centers
  • Drug and Alcohol Rehabilitation Centers
  • Emergency and Non-Emergency Ambulance Services
  • Hospitals
  • Long Term Care Facilities
  • Medical Imaging Clinics
  • Medical Testing Labs
  • Occupational, Speech and Physical Therapy Clinics
  • Pain Management Clinics
  • Physician Groups
  • Pharmacies (including those offering compounding and opioid prescriptions)
  • Telemedicine Providers
  • Solo Physicians
  • Urgent Care Clinics

 

WHAT DOES IT COVER?

  • Defense costs for actual or alleged billing errors.
  • Professional fees to conduct an audit of billing records.
  • Payment for regulatory fines and penalties (HIPAA, EMTALA, Stark proceedings).
  • Cyber and privacy coverage tailored to healthcare companies.

 

OPTIONAL EXTRAS

  • Defense of license proceedings.
  • Blanket additional insured coverage.

New Chubb Alert!

HPSI is proud to offer access to Chubb’s Business Owner’s Policies and/or Workers Comp Products designed specifically for small businesses.

Paperless PDF quote proposals and policies are generated instantly.

Receive a quote in minutes!

Appetite

Chubb BOP helps protect small business owners with up to $30M in revenue, in more than 500 business classes across the following industries:

  • Artisan Contractors
  • Clubs and Associations
  • Cultural Institutions
  • Financial Services
  • Healthcare
  • Real Estate
  • Retail Stores
  • Services Businesses
  • Technology
  • Wholesale Businesses

Optional Enhancements:

  • Property Enhancements Including A Unique Automatic Blanket Limit of Insurance Concept That Ties Together Valuable Property Coverages
  • Liability Enhancements Including Broad Named Insured and Blanket Additional Insureds
  • Privacy and Data Breach
  • Animal Bailee Coverage
  • Earthquake (In Selected States)
  • Employment Practices Liability
  • Foreign Liability Including Kidnap and Ransom
  • Electronic Data Liability
  • Water Back-up and Sump Overflow
  • Professional Liability Insurance For Dental labs, Optical Establishments, and Oral Surgeons
  • Crime, Including Forgery and Alteration, Money and Securities, and Employee Dishonesty

Total Account Solution:

Building a portfolio with Chubb means broad, state-of-the-art insurance protection all in one place. Add supporting insurance products to a Chubb BOP policy for the complete insurance solution that meets your clients needs.

  • Umbrella: Umbrella insurance from Chubb provides an additional layer of coverage over existing liability policies, offering small businesses even more insurance protection.
  • Worker’s Compensation: Chubb’s workers’ compensation policy provides small businesses an insurance solution with broad coverage, as well as Chubb’s exceptional policy and claims service.
  • Commercial Auto: Chubb’s commercial auto policy includes personal injury protection, uninsured and under insured motorist coverage limits up to $1M, as well as endorsements that include additional coverages.
  • Management and Professional Liability: Chubb’s ForeFront Portfolio suite provides additional management and professional liability insurance including employment practices, crime, and cyber liability.
  • Cyber Enterprise Risk Management (ERM)/Digitech ERM: Using a three-prong approach, Cyber ERM and DigiTech ERM incorporate risk transfer, loss mitigation services, and post-incident services to help protect against your client’s cyber risks.
  • Foreign Package: As your client’s business spans national borders, their coverage must expand, too. Chubb SCI’s foreign package policy is a mutliline coverage that protects more than inventory and intel; it protects your client’s greatest assets: it’s people.
  • General Liability

Alarming Cyber Stats!

 

More than 95% of cyber claims are for first party losses only and they fall into three broad categories:

1. THEFT OF FUNDS

This is straight forward theft of money from a company’s bank account. The fact that nearly every business can now move its money around electronically and remotely means that it is much easier to steal. Criminals no longer target physical banks – they target online accounts. And if a business has somehow been negligent in allowing this to happen, the bank will not reimburse them.

2. THEFT OF DATA

Data is valuable, and if something has value, it is worth stealing. Identity theft has reached record levels around the world and in order to commit identity theft, criminals need data. Seemingly innocuous information such as names and addresses stored on a computer network can be worth more money than you think.

3. DAMAGE TO DIGITAL ASSETS

In order to operate, businesses now have an incredibly high dependency on their systems, and criminals know that. By either damaging or threatening to damage a firm’s digital assets, attackers know that they can extort money from their victims who might prefer to pay a ransom rather than see their business grind to a halt. And even after paying up, the victim is often left with systems that are unusable and costly to fix.

In some cases, there may be no financial incentive for the attacker at all. In the same way that criminal damage to property doesn’t always have a financial incentive, damage to digital assets doesn’t need to either.

Claims for theft of funds are actually very easy and quick to quantify, but for theft of data claims, the financial impact can vary depending on the nature of the data compromised and how much of it was stolen.

The costliest part of a cyber event is often responding to the incident. For example, if an attack has managed to compromise a company’s computer network, then IT specialists are going to be needed to stop the attack, protect against further immediate threats, and work out what has been stolen.

There is then a financial cost associated with limiting reputational damage, notifying clients or customers whose data has been stolen, and offering them identity theft protection solutions if necessary.

Damage to digital assets claims can be easy to determine especially if there is an extortion demand which the victim has paid (the amount of the claim is the cost of the ransom) but more difficult if we’re talking about the cost of using IT specialists to rebuild systems or data – which might only be calculated after the work is completed.
The key point underpinning each of these types of claim is that there is a direct financial loss to the victim’s business which can be transferred with a cyber insurance policy.

 

THEFT OF FUNDS

It is worth noting that while this is one of the biggest issues facing business today, not every cyber policy includes cover for theft of funds and those that do can vary in how broad the cover offered is. Please contact us if you are interested in receiving a brochure with more information about how Cyber risk has evolved, first party risks, types of Cyber claims and more about Cyber crime.