With ICD-10 officially in effect across the health-care industry, various stakeholders are taking stock of the impact and thinking ahead to future implications. One business insurance group did just that and, as a result, has enhanced its health-care-sector coverage to include ICD-10 liability protection.
Liability for what? Well, for overbilling under the False Claims Act. The firm, the Beazley Group, added the coverage to protect providers against accusations of intentional and unintentional overbilling through improper coding.
The fear is that if Medicaid, Medicare, or other insurers begin to suspect a provider is routinely submitting claims at higher payment levels than the situation warrants, the organization might press criminal or civil charges and seek reimbursement.
The Federal False Claims Act, also know as “Lincoln’s Law,” is one of the most effective tools for combatting fraud against the federal government, and it is the government’s way of taking action to reduce waste, fraud and abuse in federal spending.
Though the idea of a criminal charge resulting from genuinely unintentional coding errors seems outlandish, the Beazley Group considered the most extreme potential scenarios—including whistleblower accusations from former employees in hostile situations—and felt the risk was great enough to warrant coverage.
Is this type of legal entanglement likely to occur? At this stage, it’s very tough to gauge. While the climate among government agencies, insurers, and providers is not currently at that level of hostility, there is no way to predict how strained relationships, or finances, might become as the effects of ICD-10 accumulate.