Defined by the Centers for Medicare and Medicaid Services (CMS) As an Aggressive Program

™ MEDEFENSE Plus Protection from Regulatory Billing Investigations

Healthcare providers, including: hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B are now A vital part of faced with the reality that the Recovery Audit Contractor (RAC) audits the proposed have spread nationwide! healthcare overhaul targets Defined by the Centers for Medicare and Medicaid Services (CMS) as an aggressive program to “find and prevent waste, an estimated fraud and abuse in Medicare,” federally hired contractors, paid $60 billion a on a contingency basis (i.e. retaining between 9%-12% of year in Medical payments recovered), have recouped more than $993 million as fraud. of 2008 in improper payments that did not meet Medicare’s coding or medical necessity policies. With a In addition to physically reviewing medical records, RACs also use electronic microscope on automated reviews searching for billing patterns that appear higher than the majority of providers in the community. Improper payments on claims can billings, is your occur for the following reasons: healthcare provider . Payments are made for services that do not meet Medicare’s medical protected? necessity criteria. . Payments are made for services that are incorrectly coded. . Providers fail to submit documentation when requested, or fail to submit enough documentation to support the claim. . Other reasons, such as basing claim payments on outdated fee schedules, or the provider is paid twice because duplicate claims were submitted. MEDEFENSE™ Plus offers coverage for RAC audits are immediate, overwhelming attorney and audit costs incurred in and burdensome response to actions . Government inquiries allow only 30 days for response. or proceedings . Government take-backs can occur in 60 days or less. resulting from RAC . Compliance and documentation are critical but not always sufficient. audit finding, as . Severe penalties can be incurred for those who are unprepared. well as payment for ™ potential fines and MEDEFENSE Plus Highlights penalties. In addition, Limits: Up to $5,000,000 each claim/$5,000,000 aggregate MEDEFENSE™ Plus Features: MEDEFENSE™ PLUS - Defense costs and civil fines and provides defense penalties coverage for Billing Errors, HIPAA, EMTALA and cost and civil fines Stark proceedings and penalties Full Prior Acts available coverage for HIPAA, STARK and EMTALA Broad definition of Billing Errors Proceedings to include both governmental and commercial payor audits and proceedings. investigations, qui tam plaintiffs, or voluntary self-disclosure Up to $100,000 legal expense coverage for disciplinary proceedings by a state Medical Board can be added via endorsement. ProAssurance Agency

New Combined Medefense™ Plus / e-MD™ Policy

Physicians and other healthcare entities are increasingly exposed to privacy related claims and things like a lost laptop, rogue employee, hacking and virus attacks can result in an embarrassing and costly loss. e-MD™ from NAS Insurance is insurance protection designed for the unique Network Security & Privacy related exposures faced by dentists, physicians, medical groups and other medical professionals. This can now be added to a MEDEFENSE™ Plus policy for a reduced rate, or purchased separately.

MEDEFENSE ™ Plus / e-MD ™ Enhanced COVERAGE COMPONENTS

. Network Security & Privacy Insurance – Will defend and indemnify insured for any claims arising out of a breach of privacy, virus attacks, denial of service, first-party HIPAA violation, and Red Flag Regulations. Includes coverage for both electronic and physical information.

. Patient Notification & Credit Monitoring Costs Insurance – If your organization suffers an information breach, most states require that you notify all the affected people that their information has been compromised. e-MD™ includes coverage for all necessary legal, PR, electronic forensics, advertising and postage expenses incurred by the insured to notify third persons of a breach of information. Will also pay for 1 year of credit monitoring for the affected people, so they can monitor their accounts and be sure there aren’t any new fraudulent accounts and/or transactions.

. Data Recovery Costs Insurance – Will pay the insured for all reasonable and necessary sums required to recover and/or replace data that is compromised, damaged, lost, erased or corrupted. This also includes software costs.

The latest round of stimulus funds set aside significant incentives for the digitization of our country’s medical records, and facilities are moving quickly to take advantage of this situation. Electronic medical records are much easier to steal/lose in bulk than paper patient files. In the last year, more than 10,000,000 identities have been exposed in healthcare related breaches; and this happened in a year when the vast majority of medical facilities have not converted to digital records. The average cost to an organization is almost $200 per identity lost. New regulations like the Hi-Tech Act and Red Flag Rules are complicating the already unpredictable regulatory environment, and will lead to an increase in Fines and Penalties. The time to discuss Network Security & Privacy Insurance with your clients is now!