Beacon Insurance Offers Medefense Policy for Medical Billing Fraud Investigations and more.
Beacon Insurance Group has partnered with Rubicon Insurance Services to offer their Medefense Plus coverage to physicians and outpatient facilities throughout South Carolina and eastern Georgia. Medefense provides insurance coverage to protect healthcare professionals for Medicare and Medicaid audits.
Medicare waste and fraud has received plenty of publicity the past number of years. The government took notice and started doing something about it. The Healthcare Reform recently brought even more light to the topic. While the Federal Government is pursuing all types of healthcare facilities that bill for Medicare and Medicaid, physicians and outpatient facilities end up being the softest targets for RAC (Medicare) and MIP (Medicaid) auditors. What is even more troubling is that whistleblowers are the chief reason audits occur. Whistleblowers can receive awards up to a maximum of 30% of any recovery per the Health Care Reform Act of 2006.
In addition to medical billing errors, a Medefense Plus policy can respond to HIPAA claim violations, Stark Law violations, and EMTALA statutes violations.
Medefense can provide coverage for legal expenses, investigation costs, shadow audits, governmental fines and penalties. Physicians have access to legal expertise from experienced professionals. Medefense Plus will also do a shadow audit of the Medicare audit to determine if the government audit is correct, but in addition will audit for under billings to see if there may be dollars available to offset the government’s audit. A few sample claims and amounts paid under a Medefense pollcy are as follows:
- A physical therapy clinic allegedly submitted false claims for services over a 2 month period when there was no licensed physical therapist staff. – Amount Paid $398,357
- Two pulmonologists allegedly violated the Anti-Kickback Statute provision of the Stark Law by accepting gifts in exchange for patent referrals to a durable medical equipment supplier. – Amount Paid $122,096
- A physician subject to routine post payment review by Medicare was determined to allegedly been reimbursed for unnecessary procedures of over $6 million. Physician hired an attorney to challenge the findings – two years later. Amount Paid – $210,000.
Having insurance protection that will cover fines and legal expenses could save a healthcare professional’s business. Even honest mistakes can be costly. When you least expect it, expect it. Medefense Plus can be the peace of mind you desire.