Managing Risk:
Regulatory Audit Coverage

Regulatory Audit Coverage (RAC)
for Home Care, Allied Health and Human/Social Services

The Recovery Audit Contractor (RAC) program was established by Congress to identify and recover overpayments in Medicare and Medicaid. Third-party contractors conduct billing audits and are paid on a contingency fee basis for overpayments found. These audits have the potential to open up a health care agency or facility to exposures involving many types of violations. 

The government has also hired Zone Program Integrity Contractors (ZPICs) to investigate fraud and abuse for all Medicare-related claims. This includes audits on providers and suppliers of Part A, Part B, Part C, the Medicare prescription drug benefit (Part D), durable medical equipment, prosthetics, and orthotics supplier (DMEPOS), home health and hospice, and Medicaid services. If a provider is selected for a ZPIC audit, the firm is either the subject of a fraud investigation or the contractor is reviewing claims information to determine whether an investigation should be open. 

Coverage Available for RAC, ZPIC, MIC and MAC Audits

To address the potential exposures that come with these audits, Manchester Specialty Programs offers very specific health care fraud and abuse insurance coverage for Home Care, Allied Health and Human/Social Services organizations. The coverage is offered as part of our Directors’ and Officers’ (D&O) Liability coverage, and is designed to respond to alleged violations of the False Claims Act and other health care fraud and abuse matters, including Recovery Audit Contractor (RAC), ZPIC, MIC and MAC audits, brought by or on behalf of the government. Our healthcare fraud and abuse component provides:

  • Coverage includes defense, audit fines and penalties
  • An early claims trigger for notice of investigation, subpoena or search warrant (as opposed to any particular kind of audit) – we can step in and help to mitigate losses from the very beginning of the process
  • Coverage options for health care fraud and abuse fines and penalties, subject to insurability under the law

Along with this insurance coverage, information is available from our carrier partner to ensure your insureds remain in compliance and are prepared in the event of an audit. In fact, our carrier was the first to bring Regulatory Audit Coverage to the health care market over 25 years ago, delivering to your insureds unmatched experience in the regulatory audit response and management of the appeal process.

Partnering with Us:
We’re Dedicated to Insuring the Health Care Industry

Our programs and insurance products are offered exclusively through licensed agents and brokers in all states (we do not sell directly to health care firms). Clients have the advantage of working with their local insurance agent or broker of choice.

If you are an insurance agent or broker, please visit our Agent/Broker Resource Center to download/complete our Producer Agreement and start working with us.

If you are a health care firm, please share information on our program and our website with your local insurance agent; they can quickly access our program on your behalf to obtain a competitive quote.

For more information about our insurance programs, please call us at 1-855-972-9399.