Medikey

AANS MediKey^SM Plan

The Smart Choice for Medicare
& Medicaid Compliance

THE CURRENT RISK

In 1981, Congress added section 1128A to the Social Security Act, authorizing the Secretary of Health and Human Services (HHS) to impose civil money penalties (CMPs). In 1996, Congress passed the Health Insurance Portability and Accountability Act, and in 1997 the Balanced Budget Act, authorizing and encouraging government agencies to scrutinize records for fraud and abuse in Medicare and Medicaid billing.

IF YOU THINK THIS CAN'T HAPPEN TO YOU...THINK AGAIN. In FY 2001, the HHS/OIG recovered $411 million in audit disallowances and $1.5 billion in investigative receivables from healthcare providers (HHS annual Report to Congress). From 1996 to 2000, civil healthcare fraud recoveries increased 539%, and "qui-tam" whistleblower recoveries increased 864%. For every $1 invested in fraud enforcement $3.62 has been returned to the Medicare trust fund. This return on investment has made healthcare fraud fighting a very lucrative activity for the government.* EXAMPLES INCLUDE: Montana Family Practice doctor -- Upcoding claims to government programs - $175,000 in "overbillings" -- five plus years in court, case settled out of court -- settlement sealed. California Oncologist -- Upcoding claims -- overpaid $57,975 -- disputed findings and won after 2 -- year fight Utah Gastroenterologist -- various allegations -- 30 visits to a grand jury at a cost of $500,000 in legal costs and $250,000 in practice administrative costs -- OIG decided not to pursue any action. *As stated in the report, Reducing Heathcare Fraud published by New Directions for Policy, September 2001

The Health and Human Services (HHS) Office of the Inspector General (OIG) estimates that improper payments under MedicareÕs fee-forservice system totaled $11.9 billion during FY 2001.The OIG credits the 50 percent decline in improper payments since FY 1996 to HHS's fraud and abuse initiatives. No provider is immune to recovery under the current frenzy of audits and investigations.

HOW DOES AANS Medikey^SM PLAN ADDRESS THESE RISKS?

AANS MediKey^SM Plan combines a recognized, effective Medicare/Medicaid compliance program with comprehensive Billing Errors & Omissions Insurance. Both components are essential in order to achieve full protection at preferred pricing.

Implementing the AANS MediKey^SM Plan takes the worry out of governmental investigations, allowing providers to focus on the practice of medicine.

PROTECTING YOUR FUTURE WITH THE AANS Medikey^SM PLAN

Adherence to a compliance program is generally considered evidence that billing is done in good faith. However, no compliance program can stop a governmental audit. The insurance protection picks up where the compliance program leaves off.

The compliance subscription includes the following tools to build an effective compliance program:

• Compliance Guide - customized for Neurosurgery and developed with input from the AANS
• Monthly Educational Updates - covering relevant areas of coding & reimbursement
• Online Billing & Coding resources
• Patient Encounter Chart Audits Ð "friendly" audits to assist neurosurgeons with chart documentation

PREFERRED RATES

The comprehensive insurance coverage provides you with the financial resources to sustain your practice without undue burden while undergoing a defense proceeding.

Coverage is underwritten by an A.M. Best A rated insurer with a preferred rating structure for AANS members. Coverage includes: Defense, Settlements, Civil Fines & Penalties and "Shadow Audits."

OTHER FREQUENTLY ASKED QUESTIONS.

Q. What is the government investigating?

A. Alleged healthcare fraud and abuse and overall billing practices to federal and state healthcare programs.According to the HHS/OIG, in 2000, 6.8% of all Medicare billing was paid inappropriately.

Q. How are the investigations initiated?

A. Investigations typically begin when Medicare, Medicaid or another payer detects an anomaly in billing patterns, or from random sampling.The government is also authorized to pay rewards up to 15% to 30% of recovery to whistle-blowers.

Q. Doesn't malpractice insurance cover these risks?

A. Standard malpractice policies do not protect against civil fines and many have regulatory exclusions.

Q. What are the possible consequences?

A. These are a few of the more common outcomes being experienced by providers

• Civil fines of up to $11,000 per error
• Triple Damages
• Criminal penalties, including fines and imprisonment
• Exclusion from Medicare/Medicaid and other state programs
• Requirement for providers to hire, at their own expense, an accounting firm to perform an exhaustive audit of billing records and expense, even if no wrongdoing is uncovered.
• If problems are uncovered for a recent time period, the government is empowered to assume that similar misconduct has occurred for up to six prior years, and to assess fines and penalties based on such extrapolations.