Medefense

Because the threat of a disciplinary action is all too real, TMIC policies include Medefense coverage. Medefense covers legal expenses, fines, and penalties associated with disciplinary actions, such as actions by a state medical board, a hospital review committee, or a federal regulatory agency.

Medefense is available for the following health care professionals: physician’s assistants, CRNAs/nurse anesthetists, nurse midwives, nurse practitioners, paramedics/EMTs, podiatrists, dentists, chiropractors, or pharmacists.
 

 AVAILABLE LIMITS

Legal expenses: $25,000
Deductible: $1,000 per claim.

Policyholders have free choice of counsel. However, we will waive the deductible and pay legal expenses directly if the policyholder hires an attorney from a panel provided by TMIC.

The covered disciplinary proceedings include:

  • actions by a state medical licensing authority;
  • a professional review action regarding clinical privileges;
  • a proceeding instituted by a state department of insurance, state workers’ compensation commission, state department of health and human services, the U.S. Department of Health and Human Services, or Centers for Medicare and Medicaid Services alleging medical services were performed in violation of guidelines;
  • Medicare billing audits conducted by Recovery Audit Contractors (RAC) or other private contractors as well as allegations of non-compli­ance with Medicare/Medicaid regulations or procedures; and
  • proceedings alleging violations of EMTALA, HIPAA, Stark law.
     

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