Regulatory Billing E&O (MEDEFENSE®)

Claims example

A qui tam action was filed against an urgent care facility alleging that the facility inflated its billings for urgent care medical services (also known as ‘up-coding’). The facility was reimbursed for over $1 million in defense costs under MEDEFENSE® Insurance.*

*Coverage is determined based on the specific facts and circumstances presented at the time of a claim and the language of the policy issued to the Insured. These fact patterns are intended only to illustrate the types of claims that may trigger coverage under a MEDEFENSE® policy.

Summary of coverage

Billing Errors Coverage

Reimbursement of defense costs, fines and penalties, and shadow audit expenses incurred in billing error proceedings brought by:

• Federal or state governmental agencies
• Qui tam plaintiffs
• Contractors working on behalf of the government, such as ZPIC and RAC
• Commercial payers

Coverage For Other Medical Regulatory Violations

Reimbursement of defense costs and fines and penalties incurred in HIPAA (Patient Privacy) Proceedings, EMTALA (Emergency Medical Treatment and Active Labor Act) Proceedings, and STARK (Physician Self-Referral) Proceedings.