Regulatory Audit Coverage for Specialty Healthcare Providers

January 22, 2015

Regulatory Audit Coverage for Specialty Healthcare Providers  Regulatory Audit Coverage for Specialty Healthcare Providers

Do your clients accept Medicare/Medicaid payments for the healthcare services they provide? If the answer is yes, whether they are a home health care agency, VNA or hospice care provider, they will more than likely face an audit from the Center for Medicare & Medicare Services (CMS). For the last few years, the U.S. Department of Health and Human Services (DHHS) has been persistent in their application of the Recovery Audit Program which is designed to detect and collect any Medicare or Medicaid overpayments made on claims for health care services. As a result, more and more healthcare providers are facing increased scrutiny and investigation into their billing practices.

The Recovery Audit Program originally began on a trial basis between 2005 and 2008 which resulted in the recovery of over $900 million in overpayments returned to the Medicare Trust Fund, according to the CMS. The initial audits also found $38 million in underpayments, which were returned to heath care providers. As a result Congress created the permanent Recovery Audit Program to be enforced in all fifty states by 2010. Since then, the CMS has contracted with contractors to investigate and monitor improper billing and payments and potential acts of fraud.

Third-party contractors conduct these comparative billing audits on healthcare providers across all specialties and practices, from hospitals to private home care providers. These audits have the potential to open up a healthcare agency or facility to exposures involving many types of violations which can result in fees, settlements and other financial losses.

To address the potential exposures that come with these audits, Manchester Specialty Programs offers highly focused health care fraud and abuse insurance coverage for hospice, home health care agencies, VNAs and DMEs. Our Regulatory Audit Coverage can be attained 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. These policies respond when healthcare providers are facing Recovery Audit Contractor (RAC), ZPIC, MIC and MAC audits brought by or on behalf of the government. Our Regulatory Audit Coverage is one of the many specialty policies we offer home healthcare providers to help protect their key industry members from losses. To learn more about our operation and all of our products, contact us today at (855) 972-9399.