Medikey Billing Errors & Omissions Insurance
The exclusive MediKey insurance policy from Cunningham Group provides healthcare practitioners and institutions with comprehensive coverage against allegations of fraud and abuse. We also provide a solid compliance program, the existence of which HHS1 and OGI2 take into consideration when determining the appropriate fines and penalties for billing errors and omissions.
The amendment3 of the Social Security Act in 1981, coupled with the HIPAA4 of 1996 and Balanced Budget Act of 19975, created a storm of investigation into fraud and abuse in billing to Medicaid and Medicare. Between 1996 and 2001, such actions led to a 50% decrease in improper payments, but the 2001 total were still nearly $12 billion. The Office of the Inspector General attributes half of that decline to the fraud and abuse initiatives of HHS.
What does the MediKey Plan offer?
While the existence of a compliance program and adherence to its provisions can indicate a good faith effort to ensure validity of billing, it will not prevent an audit. Your MediKey Billing Errors and Omissions policy can, however, relieve the stress of a RAC audit or other governmental investigation. We realize that you want to dedicate your energy to the practice of medicine, not the business of medicine.
MediKey coverage includes the following:
- Civil fines & penalties
- â€śShadow auditsâ€ť
- Defense and indemnity coverage for Stark, HIPAA and EMTALA violations
For protection against allegations of fraud and abuse, including RAC audits and violations of Stark6, HIPAA or EMTALA7, MediKey is the key. Enjoy the peace of mind that is gained by knowing you and your practice wonâ€™t be decimated by such allegations.
While having a comprehensive compliance program in place, and strictly adhering to its guidelines is a crucial part of protecting yourself, the comprehensive protection of a low cost MediKey Billing Errors and Omissions insurance policy provides optimal protection.
Our exclusive MediKey Plan is underwritten by an insurance company that is rated â€śA++â€ť (superior) by A.M. Best. Thatâ€™s the highest rating any insurance provider can receive. And in a litigious society, every healthcare provider must demand the very best protection available. Thatâ€™s us!
What are the risks?
The consequences of an unfavorable audit can be very substantial, including these common outcomes:
- $11,000 civil fine per error
- Triple damages
- Criminal penalties, which can include both fines and imprisonment
- Mandatory hiring of an independent accounting firm to audit all billing and expenses, even if no wrongdoing is found. This is at the providerâ€™s own expense
- If deemed necessary, the government can assume that recent misconduct existed for up to six previous years and can assess penalties and fines based upon that extrapolation
- Exclusion from participation in Medicare/Medicaid, as well as other state programs
Itâ€™s important to realize that the standard malpractice insurance policy typically will not protect you or your practice against either civil fines or regulatory penalties. The Cunningham Groupâ€™s MediKey Plan fills that gap in coverage, as well.
Contact us now for a no-obligation explanation of how our low-cost MediKey Plan can protect your practice from government investigations of fraud and abuse. Our expert counselors are ready to assist you.
- Health and Human Services
- Office of the Inspector General
- Section 1128A was added to the Social Security Act, authorizing the Secretary of Health and Human Services to assess civil penalties for improper billing.
- The Health Insurance Portability and Accountability Act of 1996 amended the Internal Revenue Code of 1986 to combat fraud and abuse in Medicaid and Medicare billing and allow for recovery of losses and assessment of penalties.
- Balanced Budget Act of 1997 further tasked government agencies with detecting abuse and fraud in Medicare and Medicaid billing, recovering losses and assessing penalties.
- Stark â€“ The Stark Law prohibits providers from billing Medicare or Medicaid for certain designated healthcare services referred by physicians with financial relationships with those providers.
- EMTLA stands for the Federal Emergency Medical Treatment and Labor Act
If you would like to learn how Cunningham Group can help you, please call us at 866-824-0137 or complete the form below.