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Basic E&O May Not Be Sufficient

A physician received a subpoena from the Office of Inspector General commanding an appearance before a special agent in connection with an investigation of possible fraudulent or otherwise improper claims submitted to healthcare benefit programs of the United States Department of Health and Human Services.

Twenty-three categories of documentation were requested to be produced by the physician, spanning 11 years of records. The dollar figures at stake were potentially in the multiple millions. The Office of Inspector General became argumentative regarding the scope of its investigation despite the fact that the federal law limits what the OIG may obtain with regards to HIPAA.

The case quickly consumed the physician’s underlying limit of billing errors and omissions insurance with their medical malpractice carrier.
Legal expenses to date: $48,000 Anticipated expenses: $300,000

Source: Actual Claim; Claims Dept. 2012

Medical Malpractice Claim “Dead On Arrival.”

A physician received a pre-suit letter of intent from a regional plaintiff ’s law firm based on an alleged negative patient outcome. The physician immediately contacted an independent provider advocate hotline who subsequently delivered sound counsel on proper communication governance and protocol going forward that included contacting their current medical malpractice insurance carrier to report the claim.

Meanwhile, the Wealth Guard executive assigned an experienced independent medical malpractice defense attorney, (in addition to the appointed medical malpractice carriers attorney) to perform an independent assessment and shadow defense of the case.

A letter was also sent to the plaintiff ’s attorney notifying them that the doctor was going to be rigorously defended, has engaged in awful asset protection prior to the suit, and is collection-proof to creditors. As a result, the plaintiffs’ attorney calculated the probability of collecting against such a rigorous defense and the case was withdrawn.

Source: Compilation of multiple Florida Medical Association physician experiences from 2005-2007.

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