What can the insurance industry learn from historical hospital losses?

Hospital losses are a problem for hospitals' risk managers and insurance companies, brokers, and agents that place the policies. Rather than deadly diseases, today's leading issue for healthcare institutions may be a wide range of hazards. Hospitals and healthcare businesses face several specific liabilities, but many more are common to other sectors.

As an illustration, consider the following scenario: Employee Retirement Income Security Act of 1974 violations cost a Catholic healthcare ministry $358.4 million in 2014 due to a settlement (ERISA). Over 70,000 hospital employees were denied essential safeguards meant to assure their financial stability in retirement because the hospital didn't fully pay their retirement plan, as per the claim. Whenever you want to get paid and medical coverage is becoming complex, you can turn to Kemberton solutions to get the help you need and minimize your out-of-pocket costs.

Hospitals are not the only businesses that suffer losses

Issues that are also prevalent in other sectors have resulted in significant losses for hospitals over the years include:

  • Breach of confidentiality of personal data. Data breaches have existed for the longest time, and they will always be a significant point of concern for any industry. It leads to vulnerability and can be the cause of massive losses.
  • Problems with confidentiality. Not disclosing vital information is one of the factors that every organization has to pay attention to. There is a lot that needs to be withheld from the public since it can have unwanted consequences once it is out there. This is a good lesson for the insurance industry, especially in avoiding unnecessary losses.
  • Violence against women and girls. Nearly a third of the world's women have been assaulted physically or sexually, usually by a spouse or domestic partner. The immediate and long-term physical, sexual, and emotional repercussions for ladies can be catastrophic, including death, if violence is used against them. This is a human rights violation and something that needs to be addressed.

Hospital losses of this sort include:

  • A hospital reached the settlement after nearly 20,000 emergency room patients' health information was accidentally breached
  • A hospital's agreement with its gynecologist after it was revealed that the latter secretly videotaped over 12,000 patients
  • A lawsuit has been filed against the pediatrician who has been accused of sexually abusing numerous patients.

Instructions on deception and negligence

Brokers and carriers also require a closer look at average losses in specific sectors. Medical facilities and healthcare groups are frequently sued because of the following reasons:

  • Misrepresentation in the medical field. Not having the proper representation has been an issue for a while, and the insurance industry should take note to avoid losing a significant amount of money.
  • Negligence. In every industry, failing to take proper care of what needs to be done will always have consequences. More often than not, you end up with unpaid bills and lots of losses to contemplate with.
  • Liability. Being legally responsible for anything has always been a concern in most industries, and often you find the responsibility being passed from one person to another. If not well accounted for, it can lead to miscommunication and failure to know who is responsible for what.

Examples of where this has occurred include:

  • Hospital’s settlement with a whistleblower alleging it paid bribes to doctors in return for referrals.
  • Fifty-five hospitals have agreed to a settlement after fraudulent Medicare claims for kyphoplasty operations were discovered.
  • A hospital reached a settlement after a lady died as a result of a misdiagnosis.

Be prepared for anything

The insurance business must also prepare for crucial but rarely addressed cases, such as the following:

  • A hospital's reimbursement for property damages done by a lightning strike in one of Dutchess County's most devastating fires in recent memory
  • Hospitals deal with an individual who sued for emotional anguish, saying the hospital left his mother's body to rot.

There will always be issues arising, and it is not every time some of these cases will be anticipated beforehand. There is no way to know for sure what to expect, and that is why one of the essential lessons that the insurance industry has to come to terms with is expecting the unexpected. You never know what might come your way, so preparation and being flexible should be among the priorities.