Broad Regulatory Protection Policy
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Since early 1999, OMIC has provided its professional liability policyholders
with free legal reimbursement coverage up to $25,000 for fraud and abuse
allegations related to physician billing practices as an added benefit of
maintaining malpractice insurance through OMIC. The policy has been enhanced
several times between 1999 and 2007 to include coverage for HIPAA privacy
violations, civil proceedings, qui tam (whistleblower) allegations, private
payer billing investigations, and EMTALA, Stark Act, and DEA investigations.
Known as the Broad Regulatory Protection Policy, the program now extends
coverage for the risks listed above to include fines and penalties (where allowed
by law) as a standard policy feature. As a benefit of membership, OMIC purchases
a $25,000 Broad Regulatory Protection Policy for each of its professional
liability policyholders. Higher limits for this new policy are available at the
same competitive rates charged for the previous policy. The Broad RegulatoryProtection
Policy is also offered for all members of the American Academy of Ophthalmology
to purchase.
OMIC professional liability policyholders automatically receive their $25,000 Broad
Regulatory Protection Policy upon purchase or renewal of their malpractice
coverage. The new policy is written to extend this coverage, at standard limits
of $25,000, to any active OMIC professional liability policyholder, therefore
a declarations page is not necessary and will not be produced for OMIC insureds
unless additional coverage is purchased. To review and download their standard Broad
Regulatory Protection Policy coverage, OMIC policyholders may sign into
the members-only section of this
web site. A link to these documents will be forwarded to all active policyholders
for whom we have a valid and current email address. Policyholders who wish to
have a hard copy sent to them can request one by contacting omic@omic.com. Higher
limits to supplement the $25,000 standard policy are available for purchase at
very modest cost by completing the request form below. Academy members who are
not currently insured by OMIC for professional liability may also purchase this
coverage by completing the forms below. For more information on this program
and for assistance in applying for standard coverage (non-OMIC Academy members
only) or higher limits (both OMIC and non-OMIC Academy members), please contact
the program administrator, Medical Risk Management Insurance Services (MRMI),
directly at (800) 610-6642.
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OMIC Broad Regulatory Protection Policy Q & A
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All information is for policies incepting on or after
1/1/2007.
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What claims are covered by OMIC's Broad Regulatory Protection Policy?
This policy covers "fraud and abuse" actions related to civil investigations
or proceedings instituted by a government agency, a qui tam plaintiff (whistleblower),
or a commercial payer alleging the presentation of erroneous billings by the
insured to the government health benefit payer or commercial payer. It also covers
government proceedings based on alleged violations of the HIPAA (Health Insurance
Portability and Accountability Act) Privacy rules. Coverage is also provided
for claims related to alleged violations of EMTALA, DEA and STARK regulations.
How are billing errors investigations typically initiated?
Investigations typically begin when a Medicare, Medicaid or commercial payer
detects an anomaly in billing patterns; when competitors, patients or employees
lodge complaints; and from random sampling.
What do "fraud & abuse" investigations typically pertain to?
Billing issues that may lead to a Medicare or Medicaid investigation may include
such things as: |
Billing for services not performed
Upcoding of services
Inadequate documentation to support the services provided
Use of incorrect CPT codes
Unbundling or fragmentation of services
Providing medically unnecessary services
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What losses are covered
OMIC's Broad Regulatory Protection Policy covers reimbursement for legal
fees and expenses, certain audit expenses, and fines and penalties (when allowed
by law) assessed due to billing errors and HIPAA privacy proceedings. The policy
does not pay for any damages or return of any overbilling or profits.
Who may obtain coverage?
Individual American Academy of Ophthalmology (AAO) members and their employed
optometrists may obtain coverage. Also, business entities with two or more physician
members, all of whose physician members are individual Broad Regulatory Protection
Policy insureds, may obtain coverage
What are the policy limits?
OMIC offers several liability limits for the Broad Regulatory Protection Policy
(BRPP). Policies with liability limits under $250,000 are referred to as the
standard BRPP policy and policies with limits over $250,000 are referred to as
BRPP Plus. There is no difference in coverage terms for BRPP and BRPP Plus. OMIC
automatically purchases a standard $25,000 BRPP policy for each of its active
professional liability insureds each year. OMIC's active professional liability
policyholders may also purchase additional coverage up to $1 million above the
standard coverage that is automatically provided by OMIC. OMIC professional liability
insureds interested in purchasing additional coverage can access BRPP upgrade
forms for standard BRPP coverage and BRPP Plus at the Members Only section of
this web site.
Members of the American Academy of Ophthalmology who are not covered by OMIC
for professional liability may purchase this coverage at limits of $25,000 to
$1 million. Non-OMIC Academy members click here for application forms.
Is there any exclusion of coverage if the proceeding or investigation pertains to billing records or events prior to the policy effective date?
So long as the investigation and claim are first instituted during your policy
period, there is no coverage restriction as to when the alleged billing error
or event occurred. However, underwriting considerations may require certain policyholders
to carry a retroactive date, whereby coverage is restricted to claims based on
alleged billing errors or events occurring after the retroactive date.
Is this policy available to optometrists who are insured under an OMIC policy?
Yes. This policy is available to OMIC-insured optometrists; however, they must
purchase this coverage. OMIC purchases a $25,000 BRPP policy for OMIC physician
and entity policyholders only. Contact the plan administrator for rates and information.
Is this policy available to retirees?
Please note that although OMIC provides a free lifetime professional liability retirement
endorsement ("tail" policy) to its insureds who fully retire and have
been insured for professional liability for at least five continuous years prior
to retirement, the free limited reporting period under the Broad Regulatory
Protection Policy extends the reporting period for insured events instituted
prior to the date the current policy expires for only sixty days. An extended
reporting period endorsement for an additional 12 months of reporting past the
policy expiration date can be purchased for the expiring premium or $500, whichever
is greater.
What are the costs of OMIC's Broad Regulatory Protection Policy?
Contact a program representative at (800) 610-6642 for information about OMIC's
competitive pricing for the limits and coverage that is appropriate for your
practice.
These questions and answers are for informational purposes only. They are
not intended to be a modification of the terms and conditions of the OMIC/Academy-sponsored
insurance policies. Various coverages may not be available in all states.
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