Government agencies have targeted the healthcare industry as a source to recuperate fraudulently received federal monies. With increased enforcement power as well as large incentives for finding fraud, Recovery Auditor Contractors’ (RAC) and Zone Program Integrity Contractors’ (ZPIC) compliance enforcement actions are expanding. There is an insurance product available to protect you in the event of a governmental investigation and for claims for alleging billing fraud.
Local: (805)-371-3680 | Toll Free: (800) 240-CHIV
Protect Yourself in The Event of a Governmental Investigation
Regulatory Proceedings Coverage
Coverage Includes:
Additional Coverage:
Regulatory Proceedings Coverage
Provides reimbursement for costs incurred as a result of regulatory investigations or other proceedings instituted against the Insured:
- Governmental Entity (e.g. Center for Medicare Services)
- Any federal or state department or agency
- Any organization operating as a Medicare Integrity Program Coordinator (e.g. RAC, ZPIC)
- Commercial Payors (e.g. Aetna, HealthNet, Blue Shield)
- Qui Tam Plaintiffs (“whistleblowers”)
- Voluntary Self Disclosure under Federal False Claims
- Information disclosed to any Government Entity that may result in a Billing Errors Proceeding
Coverage Includes:
- Defense Costs
- Reasonable and necessary fees, costs and expenses incurred in the investigation, defense or appeal of a regulatory proceeding
- Shadow Audit Expenses
- Fees for services of a qualified audit professional. A shadow auditor can also provide settlement advice as a typical investigation could last between three and five years with several negotiation opportunities.
- Regulatory Fines & Penalties
- Any administrative fines and penalties an insured is required to pay as a result of a covered regulatory proceeding
- Does not include any amounts that are intended to serve as restitution or repayment of monies received by the insured
Additional Coverage:
- Stark Law
- Covers regulatory fines and penalties and claim expenses as a result of proceedings alleging violations of any federal, state or local anti-kickback or self-referral laws.
- HIPAA / HITECH
- Covers regulatory fines and penalties and claim expenses as a result of proceedings alleging violations of the Health Insurance Portability and Accountability Act.
- EMTALA Regulation
- Covers regulatory fines and penalties and claim expenses as a result of proceedings alleging violations of the Emergency Medical Treatment and Labor Act.
