The FFActs Insurance Program has been initiated to insure and provide expert legal and negotiation services to healthcare providers who have been penalized or fined in association with the unintentional overbilling of Medicare, Medicaid, and Commercial Payors.

RAC Insurance Solution:

Why is this coverage needed?

While the False Claims Act imposes liability even if the person submitting the claim does not have actual knowledge that the claim is false. A person who acts in reckless disregard or in deliberate ignorance of the truth or falsity of the information also can be found liable under the Act.

  • Anyone with a Medicare provider number is subject to an audit
  • Since 1985 - $30 billion in recoveries by the Feds
  • In 2008 thru September alone, $6 billion recovered
  • ROI for Federal Government - $15 per $1 spent
  • Commercial audits, EMTALA, STARK, HIPAA compliance
  • Providers are liable for the mistakes of billing companies

Who is auditing?

Medicare / Medicaid Audits and the impact on the healthcare industry

  • In 2006, three trial contracts issued for RACs
  • Recovered over $1 billion in three states
  • Additional RACs to be contracted
  • For every 100 bills reviewed, 70 mistakes found
  • Focused initiatives on procedures most frequently billed in error

Sample regulatory cases made against

  • A single cardiologist inadvertently overbilled Medicare for elderly patients for six years settled for $2.6 million
  • A cardiac rehab center charged with overbilling Medicare for six years settled for $1.9 million
  • An ophthalmologist accused of filing false claims to Medicare for work deemed medically unnecessary settled for $1 million
  • Two physicians accused of taking noncompliant hospital referral fees settled over $1 million
  • A hospital system self - reported potential errors settled for $60 million!

Coverage provides

  • All costs associated with defending a healthcare provider (legal, consultant, reproduction costs, shadow audit work)
  • Audit fines and penalties
  • Implementation of Corporate Integrity Agreements is not covered

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