Physicians Billing Errors & Omissions Insurance with Administrative Disciplinary Proceeding Coverage & Breach of Security Coverage

Physicians, medical groups, health care facilities and other health care industry service providers are constantly being pulled from the practice of medicine to the practice of running a business requiring exhaustive oversight. These individuals and entities are increasingly subject to an ever changing set of complex requirements, laws, and regulations imposed by commercial and government health benefit payer programs such as Medicare and Medicaid. The rules of engagement have also changed given the government's current program to hire independent auditors to aggressively seek out monetary fraud and abuse in the health care system.

Non-compliance with these regulatory mandates comes at a high cost in the form of: attorney fees and auditor fees to defend an adverse finding; restitution of fees, profits, charges or benefit payments due to the determination of an overpayment; civil fines and penalties imposed by the government; suspension, revocation, limitation, or other corrective actions against medical staff membership or clinical privileges; and exclusion from payer programs.

XN Risk® Physicians Billing Errors & Omission Insurance with Administrative Disciplinary Proceeding Coverage & Breach of Security Coverage is a tailored insurance policy that affords policyholders with broad insurance protection through the following features:

  • Access to expert counsel for leadership, assistance, and compliance with the administrative process of responding, investigating, defending, and appealing a Claim;
  • Coverage for actual or alleged:
    • erroneous reimbursement claims to a commercial payer or government health benefit payer or program
    • violations of the Health Insurance Portability and Accountability Act "HIPPA"
    • violations of Emergency Medical Treatment and Labor Act "EMTALA"
    • violations of "Stark" laws
  • Coverage for named physicians, medical groups, other health care facilities, and past or present non-physician employees;
  • Insurance for Claim Expenses associated with the hiring of specialty attorneys and auditors and other fees, costs, and expenses resulting from investigation, adjustment or defense of a Claim;
  • Insurance for Loss for which the Insured may be held legally liable including judgments, settlements, and civil fines or civil penalties imposed by a government entity;
  • Insurance for Breach of Security Claim Expenses including cost of compliance, notification, and monitoring due to a breach of security resulting in unauthorized access of computer data that results in a violation of HIPPA or similar state or federal privacy laws;
  • Insurance for Administrative Disciplinary Proceeding Claim Expenses resulting from an administrative proceeding instituted against an Insured by:
    • a governmental body responsible for licensing, regulation, or professional discipline of physicians;
    • a hospital or other health care facility that may result in suspension, revocation, limitation or other corrective action against the medical staff membership or clinical privileges of the Insured;
    • any managed care organization for provider suspension, termination, or other limitation of the participation of the Insured as a provider of Medical Services.
XN Risk®
10 King Street East, Suite 1000
Toronto, Ontario MC 1C3
Office: 416-340-6430
Fax: 877-908-1837

Please note items in bold are defined terms per the policy form.

The comments and analysis contained herein are for topical discussion purposes only and, as such, are not intended to be any type of risk analysis for the Broker, Agent, Insured, or Applicant for Insurance. Accordingly, it is asserted by XN Risk that the Broker, Agent, Insured, or Applicant for Insurance should have their legal advisors review the particulars and statements under discussion for a detailed Insurance coverage analysis. The discussion provided herein is not an interpretation - the actual policy language and attached endorsements will dictate scope of coverage in the event of a claim.

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