Does our in-house therapy department need its own coverage?

Facility professional liability covers the rendering of professional services, and the definition of that term is where the answer lives. A definition drafted around nursing and custodial care may not clearly include rehabilitative therapy, and a definition that lists covered disciplines may omit one you actually provide.

Ask for the definition to include physical, occupational and speech therapy by name, and ask for licensed therapists to be included as insureds while acting within the scope of their employment. Both are usually granted without additional premium if requested.

Two sources dominate and neither is what operators expect. The first is a fall during a therapy session or a transfer, which is a supervision claim that happens to occur in the therapy gym. The second is a claim that therapy was not provided as ordered, which is a documentation claim and often surfaces in a broader neglect case rather than on its own.

The classic malpractice fact pattern of an incorrectly performed modality is comparatively rare. Design the coverage and the risk controls around the first two.

Therapy is the single most audited area in post-acute billing. Claims that services were billed at a higher level than provided, that group therapy was billed as individual, or that therapy minutes were recorded to hit a reimbursement threshold produce federal false claims exposure, and that exposure is far larger than the malpractice exposure.

The coverage for it is billing errors and omissions, sometimes called regulatory billing coverage, which typically covers defense of a billing investigation and sometimes the cost of a self-disclosure. It does not cover the repayment of overpayments, which are not a loss but a return of money you were not entitled to.

Confirm whether your policy includes it, what the sublimit is, and whether it triggers on a request for information rather than only on a formal proceeding, since the cost begins at the first document request.

A contracted therapy company should carry its own professional liability with limits matching yours, name you as additional insured, provide primary and noncontributory wording, waive subrogation and carry its own billing errors coverage.

But the risk transfer is incomplete by design. Where the therapy company bills under your provider number, the billing exposure is yours regardless of the contract, and a plaintiff will name you for negligent selection and supervision regardless of who employed the therapist. Contract for indemnity and insure as though you will be in the case anyway.