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Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Robert W. Miller, AAI, CIC 508-957-4270.

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Presentation on theme: "Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Robert W. Miller, AAI, CIC 508-957-4270."— Presentation transcript:

1 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Robert W. Miller, AAI, CIC

2 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. A large piece of artwork fell on a patient while a physician was administering a reflex test. The art fractured the patient’s neck. Loss Scenario FTCA denied coverage for one reason: 1.Not considered a medical professional loss. Medical Professional GAP insurance company settled the claim for $175,000 under professional liability. 2

3 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Health center contracted with a physician in optometry. Optometrist dilates patient and then leaves the room. The dilated patient tries to get out of chair and falls, breaking her hip and ankle. Loss Scenario FTCA denied coverage for two reasons: 1.Contractor worked less than 32.5 hours per week and had no written contract. 2.Not considered a professional loss. Medical Professional GAP insurance company settled the claim for $225,000 after determining the proximate cause to be a professional service. 3

4 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage FTCA provides medical malpractice coverage for medical, surgical, dental, and “related activities” for acts or omissions by the deemed health center, its qualified individual providers and/or other eligible individuals. FTCA does not provide protection against: Directors & Officers Liability Cyber Security Crime 4

5 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage The acts or omissions must: Occur on or after the effective date that the CHC received deemed status; AND Are within the CHC’s approved scope of project; AND Are provided within the CHC’s approved sites/locations; AND Are within the scope of employment, contractor for services, or duties as an officer or director of the CHC; AND Are provided to a CHC patient. There are some exceptions to these rules in the event of an emergency. 5

6 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage Dual coverage is not allowed under FTCA. Health Centers may not purchase primary malpractice coverage using federal funds. Gap or wrap-around coverage is encouraged* by the government and can be purchased using federal funds. * See page 18 of the most recent HRSA Policy & Procedures Manual 6

7 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage The government may decide to revoke FTCA coverage if, while investigating an adverse event, it determines that the CHC was not in compliance with all deeming requirements. 7

8 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage Who is covered? The deemed Health Center All employees (part-time, locums, full-time, exempt or non-exempt) with job descriptions and/or contracts All part-time contractors in a primary care field of Family Practice, Pediatrics, OB/GYN or Internal Medicine Any specialty contractor who works 32.5 hours per week or more 8

9 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. FTCA Coverage Services Covered: Primary health services defined by Section 330 of the Public Health Services Act so long as the services are provided under certain criteria (next slide) Services Not Covered: FTCA does not provide a list. Gaps exist based on what is not listed as covered. 9

10 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Potential FTCA Coverage Gaps Adult immunizations at health fairs Needle exchange Criminal activities (sexual abuse or molestation) Clinical trial participation Community-wide event participation (if CHC does not conduct event) Medical students or medical residents not employed by CHC Newborn deliveries (if not in approved scope) Supervision of non-CHC employees Teaching activities offsite with non-CHC patients or non-CHC employees 10

11 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Potential FTCA Coverage Gaps These services are not required primary health services but may be granted* coverage under FTCA: Behavioral and mental health and substance abuse services; Recuperative care services; Screening for and control of infectious diseases; and Injury prevention programs. *These services must be part of the deemed CHC’s Scope of Project. 11

12 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Broadened Malpractice Coverage If it is not moonlighting and not covered by FTCA, our GAP Professional Medical Liability insurance will provide defense and indemnification via specialized in-house counsel and adjusters at the company level. 12

13 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Health Center Exposures A comprehensive insurance plan can protect your health center from: Gaps in FTCA coverage for medical malpractice Cyber Security (HIPAA violations) Directors & Officers Liability Unique Property Exposures Crime 13

14 Copyright © 2014 Community Health Center Insurance Brokers, LLC. See final slide for contact information and disclaimers. Contact Us 14 Disclaimer This presentation offers a brief description of coverages, services, and programs and we do our best to provide complete and accurate information. For exact terms, conditions, exclusions and limitations of coverages, please refer to your insurance contract and any applicable federal, state, and local laws. Robert W. Miller, AAI, CIC


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