Why Physicians Regulatory Insurance Is A Must In the 21st Century

Healthcare professionals face more threats to their business than ever. Health coverage providers and the government that have developed regulations that only works to increase the risk of being in the health field. As a result, physicians' regulatory insurance is virtually required in case your business comes under scrutiny for regulation compliance. Just a few of the risks facing medical professionals include RAC audits, commercial payer audits, STARK violations and HIPPA compliance. This is in additional to malpractice coverage, or provider stop loss insurance for self-insurers, that is needed in the healthcare profession.

Regulatory Audit Contractors (RAC) Program

Medicare launched the uses of Regulatory Audit Contractors in 2005. These contractors receive payment based on the amount of recovery they obtain. They analyze the payouts from Medicare for medical services that were performed. If there is a determination that Medicare paid too much money, then the professional must pay back the overage. During a test run of the program, the RAC audits found more than 900 million dollars in overages in just six states. By October of 2009, these audits were implemented in every state exposing every physician to the risk.

Commercial Payor Audits

Similar to the RAC audits, commercial payor audits are completed by organizations contracted by health coverage providers to investigate allegations of fraud and abuse. The audit company analyzes the records of the payouts as compared to the services actually performed. If there is sufficient evidence that there is what they consider to be abuse, a lawsuit may be filed against the medical professional. Physicians' regulatory insurance covers not only the fines, but the legal fees and representation of the medical professional in these cases.

STARK Violations

The policies that stopped what is known as self-referrals were first instated by the Omnibus Budget Recognition Act of 1989. Self-referrals are situations were a doctor refers a patient to another clinic whether they have financial interest. A financial interest could be through an investment, or through a payment arrangement or kickback. If there is suspicion of a STARK Violation, the medical professional may face a lawsuit to recover damages for referrals made purely for financial gain.

HIPPA Compliance

Health Insurance Portability and Accountability Act was first passed into law in 1996. The primary title of the act that applies to the medical field is known as the Administrative Simplification provisions. This provision established a national standard for transactions and identifiers. Additionally it developed the standards regarding the privacy and security of personal health information. This last provision is of primary concern to those in the medical field. They must receive permission from the individual to release information regarding their health. If information is leaked, the clinic is open to a lawsuit. Getting a policy will protect the doctor from lawsuits related to HIPPA.

Getting a policy that will protect your practice is of the utmost importance. To get more information on physicians' regulatory insurance, malpractice coverage or provider stop loss insurance, contact a healthcare professional policy agent today.