| MagMutual Releasing Series of AI in Healthcare Articles MagMutual, your Ortho Risk Partners medical malpractice insurer, released the first of three AI in healthcare articles. The first article, AI: Shaping Healthcare Today and Tomorrow, discusses the various uses for AI now and in the future. The second article will review the pros and cons of employing AI in the practice. And, the third article will offer the results of an internal MagMutual experiment to test how accurately Chat GPT offered diagnosis for real MagMutual diagnostic-related claims. All articles will be available on the MagMutual Learning Center as they are released. The first article can be accessed here: AI: Shaping Healthcare Today and Tomorrow. These articles are timely given the exponential use and advances in AI within medical practice. If you have questions or concerns about the use or implementation of AI within your practice, Julie, your Ortho Risk Partners Risk Consultant, is available to you via email or phone at: jjines@orthoriskpartners.com or (618) 223-9596. |
| Regulatory Claims Are on the Rise, Do You Know Your Risks? Did you know one of the benefits included in your medical malpractice coverage is coverage* for regulatory and cyber claims? Each policy includes: Regulatory Liability – $50,000 each loss / $250,000 policy aggregate Cyber Liability – $50,000 each loss / $50,000 policy aggregate Regulatory claims are on the rise. Since the inception of the False Claims Act in 1986, recoveries have totaled over $75 billion. In order to reduce such claims, or the chance of such claims, in your practice, it is important to know your risks. The most expensive regulatory matters include (% regulatory liability claims in total): Fraud and abuse government investigations (44%) Payor audits (47%) American with Disabilities Act violations (4%) HIPAA investigations (4%) The causes of these matters include: Insufficient documentation to support billing Billing for medically unnecessary procedures Upcoding (billing for a higher level of care/evaluation than actually occurred) Inappropriate referral relationships with third-party vendors (Anti-Kickback Statute violations) Ownership of compensation issues violating Stark Law Utilizing non-licensed pharmaceutical distributors Preventing regulatory matters requires an enterprise-wide approach to compliance that includes monitoring and auditing. As well, addressing regulatory concerns or inquiries from payors, government agencies and patients in a timely fashion and with consultation from your carrier and legal team can make the difference in severity ($$$), plans of correction and ongoing government monitoring. Practices with established compliance and auditing programs with policies and procedures to address these risks are one-step ahead of the game. Your MagMutual and Ortho Risk Partners risk team is available to provide guidance and resources for your program. If you receive an inquiry from a governmental agency or staff/contractor/patient complaints alleging noncompliance related to these risk areas, it is imperative to investigate and report such matters to your carrier(s) immediately. If you have questions or concerns related to regulatory compliance, investigations or complaints, Julie, your Ortho Risk Partners Risk Consultant, is available to you via email or phone at: jjines@orthoriskpartners.com or (618) 223-9596. *Reported matters are reviewed against policy language and terms to determine if coverage is available. Understanding Your Regulatory Risks & How to Prevent Them, 3/24, retrieved from MagMutual.com. |
