IronHealth, the specialty healthcare unit of Ironshore Inc., has expanded its government billing errors & omissions product suite to include a policy form tailored to meet the needs of managed care organizations (MCO). Similar to the healthcare provider policy form, this new solution, designed as a policy option, is intended to provide coverage to protect MCOs during the course of in-depth government audits and investigations of their Medicare and Medicaid billing practices. In addition, the existing healthcare provider, as well as the new MCO policy form, has been enhanced to integrate with other coverages that an organization may purchase, specifically managed care E&O for MCOs and D&O for healthcare providers.
“As payers of healthcare services for government funded programs, such as Medicare and Medicaid, MCOs are subject to the same audit scrutiny as healthcare providers seeking reimbursement for services,” said Matt Dolan, president of IronHealth. “Healthcare reform has increased the number and intensity of audits conducted by Regional Auditing Companies (RAC) on behalf of the government with MCOs now coming on to the radar screen due to the number of beneficiaries participating in managed care plans.”
Last year, federal prosecutors had 1,787 pending healthcare criminal fraud investigations involving 2,977 defendants. They negotiated approximately $2.5 billion in judgments or settlements and returned over $18 billion to the Medicare Trust Fund. In addition, the RAC pilot program is complete as all states have hired RAC contractors.
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