By Kimberly Wittchow, JD
OMIC Products Associate
[Digest, Winter, 2000]
The government's zeal for cracking down on Medicare/Medicaid fraud and abuse continues unabated. In January, President Clinton announced plans to invest $48 million in yet another initiative to halt fraudulent Medicare claims. The American Medical Association has expressed concern that the Health Care Financing Administration is exaggerating the degree of the problem and cites a recent Department of Health and Human Services Office of the Inspector General finding that only 3% to 4% of Medicare bills resulted in improper payments, significantly fewer than the 10% to 22% that HCFA has stated are fraudulent. The AMA plans to seek legal or legislative redress to restrain government officials from making unfair accusations of health care fraud and abuse.
Meanwhile, it is imperative that physicians protect themselves in case of governmental allegations of Medicare or Medicaid fraud. OMIC has offered its Medicare/Medicaid Fraud and Abuse Legal Expense Reimbursement Insurance product since January 1999. The coverage pays for attorney's fees and associated expenses rendered in the defense of civil governmental proceedings related to allegations and investigations of billing fraud and abuse. OMIC provides coverage at the basic limit of $25,000 per insured free of charge to its medical professional liability insureds - both individual physicians and their business entities, such as medical partnerships, corporations, and professional associations.
Members of the American Academy of Ophthalmology who do not have an OMIC professional liability policy may purchase this coverage for themselves, their employed optometrists, and business entities for a $250 annual premium per insured.
Higher Fraud & Abuse Limits
This year, OMIC added several important enhancements to its fraud and abuse program.
Excess limits. All OMIC fraud and abuse policyholders are eligible to purchase excess limits of $25,000 (total limits $50,000) and $75,000 (total limits $100,000). The annual premium per insured for this additional layer of coverage is $225 and $575, respectively. All members of a group must carry the same limits. Discounted rates for group excess limits may be available for practices of ten or more physicians.
Group limits. OMIC has lifted the group aggregate limits and corresponding group aggregate deductibles. Thus, individual insureds within a group may now stack their limits for a higher total practice limit, as long as the individual insured is named in the proceeding.
Risk management. Insureds are encouraged to take advantage of OMIC's risk management programs on Medicare/Medicaid billing errors and fraud and abuse issues, including audioconferences, live seminars, and compliance planning materials. In addition, OMIC risk management providers are available by phone to answer questions and, if necessary, direct callers to OMIC's health care fraud attorney for consultation.
More Protection for Employers
Claims of sexual harassment, discrimination, and wrongful termination in the workplace are also causing physicians to take precautions in their practice. OMIC has responded to the employment practices insurance needs of Academy members by improving upon its Employment Practices Liability Insurance program.
Definition of insured. The definition of who is covered has been broadened to reflect the realistic make-up of physician practices in the new century. Corporations and their stockholders, partners or coventurers and their spouses, employees, and volunteers are all insureds under this policy. Further, an employee is liberally defined to include any executive officer or director, seasonal and temporary workers, leased employees, and independent contractors who claim to be employees of the insured.
Punitive damages. In states where punitive damages may be lawfully covered by insurance, OMIC will provide punitive damages coverage to every insured, at no additional charge.
Risk management manual. OMIC's EPLI underwriter, NAS Insurance Services, Inc., has created a guide to help insureds identify and pre-vent employee and nonemployee discrimination, harassment, and termination claims. In addition, OMIC and NAS continue to offer 30 minutes of free risk management advice from attorneys at the toll-free employment practices telephone hotline.
For more information on OMIC's Medicare/Medicaid Fraud and Abuse Legal Expense Reimbursement Insurance or Employment Practices Liability Insurance, please contact Kim Wittchow at (800) 562-6642, ext. 653 or kwittchow@omic.com.
