Provided by Cyber & Professional Lines Group

Regulatory Billing E&O (MEDEFENSE®)

As a healthcare provider, your clients face unique medical billing and regulatory exposures that their medical malpractice policy may not cover. How do we know? Consider this...

Target classes

  • Physician Groups
  • Allied Health Facilities
  • Hospitals
  • Long-Term Care Facilities
  • Mental Health Facilities
  • Solo Physicians
  • Home Healthcare Agencies

Highlights

  • Billing errors coverage - Reimbursement for defense costs, fines and penalties, and shadow audit expenses incurred in billing error proceedings, including qui tam actions

  • Coverage for other medical regulatory violations - Reimbursement of defense costs and fines and penalties incurred in HIPAA proceedings, EMTALA proceedings and STARK proceedings

  • Broad policy language and free choice of counsel

Claims example

A qui tam action was filed against an urgent care facility alleging that the facility inflated its billings for urgent care medical services (also known as ‘up-coding’). The facility was reimbursed for over $1 million in defense costs under MEDEFENSE® Insurance.*

*Coverage is determined based on the specific facts and circumstances presented at the time of a claim and the language of the policy issued to the Insured. These fact patterns are intended only to illustrate the types of claims that may trigger coverage under a MEDEFENSE® policy.

Summary of coverage

Billing Errors Coverage

Reimbursement of defense costs, fines and penalties, and shadow audit expenses incurred in billing error proceedings brought by:

  • Federal or state governmental agencies
  • Qui tam plaintiffs
  • Contractors working on behalf of the government, such as ZPIC and RAC
  • Commercial payers

Coverage For Other Medical Regulatory Violations

Reimbursement of defense costs and fines and penalties incurred in HIPAA (Patient Privacy) Proceedings, EMTALA (Emergency Medical Treatment and Active Labor Act) Proceedings, and STARK (Physician Self-Referral) Proceedings.

Get in touch
Kareen Boyadjian

Vice President, Underwriting - Product Leader

For Brokers

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For Policyholders

It's all in the data. As a response to the ever-changing threat environment, we utilize data and artificial intelligence (AI) techniques to stay ahead of threat actors, mitigate the damage they cause by identifying and cataloging daily attack vectors measured in real time against client vulnerabilities. Explore to learn more.

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Documents & forms

Your team

Directory
Head office

16501 Ventura Boulevard, Suite 200
Encino, CA 91436

(818) 382-2030
Kareen Boyadjian

Vice President, Underwriting - Product Leader

why choose tmhcc

Why choose Tokio Marine HCC?

Tokio Marine HCC is a leading specialty insurance group with offices in the United States, Mexico, the United Kingdom and Europe, transacting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance.

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Not all products, coverages, or features may be available in all states. Restrictions, exclusions, limitations, and conditions apply and you should see your agent for more information. Certain products and services are provided through non-admitted insurance carriers and are not subject to certain State Guaranty Funds.