CAP members face a variety of challenges in their medical practice in addition to lawsuits by patients. CAP members may also encounter Medical Board inquiries, regulatory investigations or complaints about Medicare/Medicaid fraud or abuse, and even discrimination lawsuits brought by former or current employees.
To deal with these other challenges, all CAP members have valuable benefits available to them through CAP’s MedGuard Plan and Employment Practices Plan.
The MedGuard Plan is a benefit that provides reimbursement of up to $25,000 in legal expenses for qualifying disciplinary proceedings. Under the MedGuard Plan, you may be eligible for benefits related to certain regulatory issues, including:
- Medical Board of California investigations, interviews, and accusations related to patient care – The Medical Board has fielded an increasing number of complaints and referred a substantial number of cases for further disciplinary action. It is often prudent to seek legal assistance from the outset of any investigation.
- Government investigations/lawsuits for alleged Medicare/Medicaid fraud or abuse or alleged violations of HIPAA – These types of investigations often require responses and deadlines that cannot be ignored and should be addressed with the assistance of an attorney.
- Hospital peer review, credentialing, and privileges issues – It can be difficult to navigate the peer review process or to know your rights under the staff bylaws without legal representation.
The Employment Practices (EP) Plan is a benefit that provides reimbursement of up to $50,000 in legal expenses for qualifying employment events. Under the EP Plan, you may be eligible for benefits related to certain employment issues, including:
- Lawsuits alleging harassment, discrimination, retaliation, or wrongful termination.
- Written charges or allegations brought by California’s Department of Fair Employment and Housing or the federal Equal Employment Opportunity Commission for alleged harassment, discrimination, retaliation, or wrongful termination and request a response from the employer.
It is important to notify CAP as soon as possible about any incident, regulatory investigation, or lawsuit that may qualify for these benefits. You should contact CAP immediately about these issues because the reimbursement benefits of the MedGuard and EP Plans do not go into effect until you notify CAP about the incident, investigation, or lawsuit. The reimbursement benefits of the MedGuard and EP Plans do not apply to any legal expenses incurred before you notify CAP about the incident, investigation, or lawsuit.
By notifying CAP immediately, you will: 1) get a prompt determination of whether the incident, investigation, or lawsuit is eligible for reimbursement benefits under the MedGuard Plan or EP Plan; 2) receive assistance in locating a qualified attorney; and 3) maximize the benefits that may be available to you under these plans.
Please note that there are deductibles, conditions, and exclusions applicable to both plans.
To learn more about the MedGuard Plan or EP Plan, you can access the “Member Login” page and click on the “Member Coverages” tab. To report an incident, investigation, or lawsuit that may be eligible for MedGuard Plan or EP Plan benefits, please contact the Claims and Risk Management Hotline at 800-252-0555.
Additionally, the CAP Physicians Insurance Agency, Inc. (CAP Agency) can provide you with information regarding Medefense Plus and Employment Practices insurance that will provide you added protection with additional coverage and policy limits.
Doug Shin, JD is CAP’s Associate Counsel, and Ann Whitehead, JD, RN, is CAP’s Vice President of Risk Management and Patient Safety. Questions or comments related to this article should be directed to dshin@CAPphysicians.com.