Medical Billings E&O and Regulatory Defense Policy

PUA’s medical billings errors & omissions and regulatory defense policy provides first party coverage for defense costs and regulatory fines or penalties resulting from actual or alleged billing errors. Coverage is applicable for claims brought by entities including, but not limited to:

  • Governmental Agencies
  • Contractors working on behalf of the government including but not limited to Recovering Audit Contractors (RAC) and Zone Program Integrity Contractors (ZPIC)
  • Qui Tam Plaintiffs
  • Commercial Health Insurance Payers

The policy also provides coverage for regulatory actions involving Billings Error Proceedings; Health Insurance Portability and Accountability Act (HIPAA); Physician Self-Referral (STARK); Emergency Medical Treatment and Active Labor Act (EMTALA); and more.

Policy Features

Max Limit: $2MIL/$4MIL
Min Premium: $2,000
Min Retention: $2,500

Coverage Features

  • First party billing & coding coverage for actual and alleged billing errors
  • Coverage included for claims expenses, shadow audit expenses, and regulatory fines/penalties (to the extend insurable by law)
  • Worldwide coverage
  • Choice of counsel available
  • Coverage included for Voluntary Self Disclosure
  • Coverage included for independent contractors
  • Full Prior Acts for Unknown Claims
  • Innocent Insured coverage
  • Shadow auditing expenses included (i.e. an audit performed by a qualified professional, who examines the same billing records and related documents as those subject to an ongoing billing errors proceeding, with the intent of providing an Insured with a private expert opinion.)
  • Consent to Settle (with soft hammer)
  • PUA policy form #PUAMB062016 available upon request.

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