In a world where lawsuits are common, appropriate insurance coverage is a necessity. Because every organization’s insurance needs are a little different, Brown & Brown is always available to help sort through risks and provide solutions to meet all of an organization’s insurance needs.
A newer insurance coverage is available for billing errors and omissions. As of now, the need for this coverage seems directly proportionate to organizations’ percentage of mental health services. The demand for this coverage increases with the more billing to Medicare, Medicaid, and commercial payers an organization does, along with the number of different codes available for billing. The most common causes of claims arising from the treatment for which Medicare and Medicaid claims are submitted typically arise out of one of the five areas of treatment.
- Total Neglect or No Services Provided: An agency bills for services not accounted for or provided
- Worthless Services: A provider may be held liable for submitting claims for services rendered if the services are so deficient that there was no medical value or necessity
- Inadequate Services: Although the services may not be considered worthless, they may be severely deficient, entitling the government to some reimbursement for its expenditures
- Standard of Care: Statutes and regulations governing Medicare and Medicaid require providers to meet quality of care standards. Failure to meet these standards may expose the facility to False Claims Act liability
- Aggressive Treatment: A provider may try to dramatically increase its profits for multiple procedures if it is reimbursed for unnecessary services rendered, resulting in overbilling
The more research Brown & Brown does on this, the more it seems like a primary risk would be a qui tam/whistleblower complaint alleging fraudulent billing practices. The company also has seen billing issues resulting from Misrepresentation of Credentials, Upcoding or Improper Coding of Services, and misrepresentation of patient data.
Brown & Brown Coverage Can Protect Your Organization
For a pricing indication for this coverage (or more information on this or any other insurance matter), email Tiffany Vrabel of Brown & Brown the following information:
- Location address
- Description of your operation
- Gross annual projected billings
- Net annual projected billings
- Employed physician numbers (full versus part-time)
- Whether you or any member of you staff or any entity for whom you perform billing services ever had to refund amounts to public and/or private payers in the last three years?
- If ‘yes’, please provide the amount and details on the reimbursement
Brown & Brown partners with the Alliance for Strong Families and Communities to address risk mitigation through the Alliance’s operations support services. By working with the Alliance, organizations can develop risk management expertise and custom risk management plans and policies.
The Alliance’s full suite of operations support services addresses administrative needs so organizations can focus on their missions. Services include human resources and other strategies for attracting and retaining talent, accounting and bookkeeping services, and risk mitigation services.