Texas Medical Liability Trust (TMLT) policyholders audited under Medicare's Recovery Audit Contractor (RAC) [ PDF ] program are now covered. TMLT says its Medefense [ PDF ] coverage reimburses legal expenses up to $25,000 per annual policy period for disciplinary proceedings and includes up to $5,000 per annual policy period for audit expense.
Expense reimbursement requests are subject to the terms and conditions of the endorsement and the policy, which contain a deductible and a coinsurance clause, TMLT says.
Changes to the Medefense endorsement were:
- The 10-percent coinsurance clause per insured event is waived if a physician selects an attorney from a panel provided by TMLT/Texas Medical Insurance Co.
- The definition of disciplinary proceedings now includes actions against the physician that allege violations of the Emergency Medical Treatment and Active Labor Act, the Health Insurance Portability and Accountability Act, and Stark laws.
- Coverage for proceedings instituted by the U.S. Department of Health and Human Services was clarified to include any Centers for Medicare & Medicaid Services allegation that the physician performed medical services in violation of RAC guidelines.
For more information on these changes or other policy information, call TMLT at (800) 580-8658.
Action , Feb. 15, 2010