Julie Shumer – Professional Medical Insurance Company

by Richard Stokes

One of the things that I enjoy most about being a member of the North Fulton MGMA is the content that we get from the speakers; I always come away with something new.

For January, our presenter was Julie Shumer with Professional Medical Insurance Company (PMIC).  Since I am not well versed in the insurance and liability side of healthcare I was interested in learning something new.  Julie’s approach was to deliver a broad presentation on the major coverage’s that practices should carry and the areas she covered were:

  • Medical Professional Liability (MPL)
  • Workers Compensation
  • Business Owners Package (BOP) or Commercial Property Package (CPP)
  • Employment Practice Liability (EPL)
  • Flood (National Flood Program)

What I found most interesting were 2 areas where claims and practice exposure have significantly risen in the last few years:

Employment Practice Liability – At a high level this deals with things such as wrongful termination, sexual harassment and discrimination among other things.  Julie stated that EPL claims have risen upwards of 50% in recent years and is the #1 exposure for today’s practice.  Furthermore what I thought was interesting was that these claims haven’t been in areas I would have expected like wrongful termination or discrimination.  Rather, the single biggest contributor has been from 3rd party vendors for something such as a breach of contract.  In Julie’s experience these claims have been very costly to the practice involved.

Medical Defense Coverage – This is normally a component of the standard MPL Policy.   However, in the event of an investigation by the Office of the Inspector General (OIG) the policy is only going to cover the practice for defense and will not cover any fines or the cost of the actual audit.

Why is this important?  Well investigations are on the rise and they’re coming to your town.  In an effort to clamp down on fraudulent Medicaid and Medicare claims, the OIG’s presence has grown and so practices that see lots of Medicaid and Medicare patients can expect to be much more susceptible to such an investigation.

When I moved to Atlanta over 10 years ago I was told that when it comes to Atlanta traffic, it’s not ‘if’ you have an accident, but ‘when’.  And when I talked to Julie about Medical Defense Coverage she said the same thing; it’s not ‘if’ you get investigated, it’s ‘when.’

The bottom line is insurance is complicated and it’s important to work with a professional that can inform you of the options, ask the right questions and ensure that the practice is properly covered in all areas.  In many cases, especially in the two areas mentioned, it might make sense to look at a standalone policy.

Network 1 Consulting is a 13-year-old, IT Support company in Atlanta, GA.  We become – or augment – the IT department for professional services companies: medical practices, law firms and financial services firms.  Our IT experts can fix computers – but what our clients really value is the industry-specific best practices we bring to their firm.  This is especially important with technology, along with regulations and cyber threats, changing so rapidly.  We take a proactive approach to helping our clients use technology to gain and keep their competitive advantage.

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