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Captive Healthcare Programs

Captive Healthcare Program Through the creation of our Captive Healthcare Program, The Littleton Group has become the largest third party administrator of healthcare claims and litigation in the Turks & Caicos Islands (“TCI”), and also services captives in St. Vincent and Anguilla.

Claims Administration of a Captive Healthcare Program requires specialized skills different from those of the typical insurance or self-insured claims administration program. As a result, The Littleton Group has set up a distinctly separate unit solely dedicated to Captive Healthcare Programs.

We have continuous interactions with insurance regulators and auditors in the TCI, and know their expectations and requirements for claims administration. We will work to ensure that your captive not only meets those requirements, but exceeds them.

Our dedicated team stands ready to assist you in a wide range of captive needs.

Why use the Littleton Group as your Captive Healthcare TPA?

Our Captive Team:Donna Gutierrez is our Director of Captive and Healthcare Programs. Donna has an extensive background in Program and Claims Management. Her expertise includes medical malpractice, professional liability, and occupational injury claims.

Our Captive Healthcare Program is comprised of a separate specialized unit with the expertise and knowledge of captive and healthcare regulations.

The senior claim analysts that work under Donna’s direction in this unit are placed there because of their background, experience, and exceptional claims expertise. These professionals understand the nuances of a captive insurance company and healthcare regulations that affect Medicare/Medicaid reimbursement.

Our Captive Team further consists of a Licensed Risk Manager, Ray Luedke, who also serves as Director of TPA Programs. Ray brings a wealth of experience in data management and claims administration. His expertise includes assessing and evaluating various forms of risk and providing advice and recommendations for risk reduction and elimination.

Our team will work with you to create a program customized to your individual needs, working to make your captive the most efficient financial vehicle it can be.

Healthcare Reimbursement:We will ensure that your claims administration program is in compliance with federal healthcare reimbursement regulations.

The PRM-15 not only requires a healthcare provider to select the type of arrangement which is most reasonable and prudent, it also requires the captive insurance company to have an adequate claims management and risk management program.

Under Publication 15-1, The Provider Reimbursement Manual (“PRM-15”) promulgated by the Centers for Medicare and Medicaid, healthcare provider costs incurred for protection against malpractice and comprehensive general liability are allowable for insurance purchased from a limited purpose insurance company, or captive.

Captive Regulatory Requirements:We ensure that your claims administration program exceeds the insurance regulatory requirements of the TCI, St. Vincent and Anguilla. This safeguards the integrity of your captive’s licensing requirements in these venues.

Captives are subject to periodic audit by insurance regulators in a particular venue, as well as outside independent financial auditors. We work directly with the regulators and auditors in your captive’s venue, and as your claims administrator, respond to their requests for all required information.

Through the utilization of our electronic data system, we assist your captive in exceeding the requirements and expectations of the regulators and auditors. This is done through our reporting of continually updated “real time” electronic file notes and financial data.

We understand the importance of maintaining the sound structure of your captive through meeting all offshore regulatory requirements, and will utilize our claim professionals and tools to guarantee these are eclipsed.

HIPAA Compliance:We will assist you in complying with the Health Insurance Portability and Accountability Act (“HIPAA”) when responding to a request for medical records. HIPAA is a federal law that requires healthcare providers to safeguard the protected health information (“PHI”) of its patients. PHI under HIPAA is very specific and includes names, telephone numbers, addresses, dates directly related to an individual, e-mail addresses, medical records, account and social security numbers, automobile license plate and serial numbers, as well as other categories information.

Our knowledge and understanding of HIPAA enables us to advise our clients whether a party is entitled to the medical records requested, and whether the authorization fully complies with all requirements of HIPAA.

We routinely handle requests for records from:

  • Family members
  • Attorneys
  • Records retrieval services
  • Law enforcement officials
  • Insurance companies

We always maintain the confidentiality of protected health information.

Long Term Care Facilities Coverage:Our clients encompass a broad spectrum of long term care facilities, including but not limited to skilled care nursing homes, assisted living centers and retirement communities.

Upon receipt of a claim, we contact the facility to ascertain the dates of residency, since those dates are directly tied to the potential exposure period. We will next conduct a thorough investigation of the claim, consisting of a review of the medical records and interviews with facility staff, as appropriate. We will then analyze any potential liability and communicate the results of our findings to the insured.

In cases of significant exposure, the review of the medical records by a registered nurse or doctor is sometimes warranted. In that event, we have a network of registered nurses and doctors with long term care experience, who will review the records and provide initial impressions on standard of care issues.

In the event a lawsuit is filed, we will retain defense counsel to vigorously defend the case and protect the insured’s interests. We always retain counsel for the insured from our network of seasoned trial attorneys who possess the training and experience necessary to defend a long term care case. These attorneys are carefully screened by our claims analysts in advance, and we will ensure the client is kept informed of the case status through regular and timely reporting.

Physicians Coverage:The Littleton Group assists physicians in managing professional liability claims and risks, and provides programs structured to meet our clients’ individual needs. Throughout our entire proactive claims and litigation management process, we work diligently to protect the insured’s reputation and future.

Upon notice of claim, we will commence a thorough investigation, contact plaintiff’s counsel to determine the nature and extent of the allegations, the status of the plaintiff’s condition and their prognosis for recovery (if applicable). Once we have obtained and reviewed the pertinent medical records, we will procure a qualified medical expert to complete an initial assessment of the medical treatment rendered. The selection of this expert is based on criteria including education, training and expertise in a given discipline. The expert’s findings are communicated to the insured and a preliminary plan of action is formulated.

In some instances, certain matters are targeted for discussions with plaintiff’s counsel, oftentimes leading towards an equitable solution. In other cases, the insured’s medical expert’s positive review of the care rendered is discussed with plaintiff’s counsel, sometimes resulting in the plaintiff choosing not to pursue the claim.

Often the insured’s first notice of a claim is a lawsuit. Upon receipt of a lawsuit, we will immediately retain a highly qualified and experienced trial attorney on their behalf. Thereafter, we will work together cooperatively with defense counsel to ensure our client is kept informed and updated throughout the duration of the case.

Litigation Management: The Littleton Group excels at controlling litigation costs. Not only do we monitor defense counsel, but direct them in concert with you, our client, to obtain the best legal result possible. In addition, we have carefully selected healthcare attorneys across the U.S. to aggressively defend our clients.

All of the attorneys who represent our clients have been chosen because of their experience in defending long term care facilities and medical professionals. They are knowledgeable with the standards of care particular to each facility or medical discipline, and are familiar with the local courts and attorneys in the area where the case is pending.

In addition to experience, we have partnered with specific attorneys because of their understanding of the captive prograrn. They realize the importance of an aggressive defense, coupled with an economic approach to defending your case.

Finally, because we know how stressful a lawsuit can be, we require all attorneys who represent our clients to ensure you are kept apprised of the status of your case. This includes an initial evaluation, regularly updated reports and summaries, timely notification of important dates, and an itemized budget of estimated legal costs.

During the entire process, we closely manage expenses while providing guidance and support in the defense of your case.

Risk Management:The Littleton Group maintains independent trending and tracking information, as required under federal regulations. This data is captured and transformed into meaningful tools that enable our clients to identify, isolate and eliminate the source of many areas of risk inherent to the healthcare industry.

Through our customized risk management data functions, we are able to track many types of incidents, such as:

  • Falls from beds, wheelchairs, and those resulting from unassisted transfers and loss of balance
  • Development of pressure sores
  • Swallowing/choking issues
  • Altercations
  • Medication issues

We understand not only that a risk management program is required by federal regulations, but that the identification and reduction of risk in your daily operations is vital to the success of your captive.

Data Administration:Our electronic data management program is state of the art and provides loss data in “real time.” This data is available 24 hours per day in a wide variety of standard and customized reports.

We interact with you, your captive manager and actuary by providing detailed financial information with itemized summaries of all incurred and paid expenses. Not only does this enable us to closely monitor all file expenses, it ensures the accurate reporting and booking of the financial data for maintaining the integrity of your premium calculations, loss ratios and similar information required by both U.S. federal and offshore regulations.

We also record and report all factual data connected with each claim and incident. This information is then translated into useful tools for risk management training purposes, and also assists you in maintaining accurate trending and tracking data, as required by federal law.

Customer Service:We provide unparalleled customer service to our captive healthcare clients by:

  • Providing updated paper and/or electronic reports and loss runs, both on demand and at your pre-determined intervals
  • Customizing our handling and protocols for each individual client to suit their specific needs
  • Availability of our management team and claims analysts 24 hours per day by phone and e-mail
  • Working with you to make your captive the most efficient financial vehicle it can be

At The Littleton Group, we pride ourselves on our professionalism, experience and responsiveness. Our Captive Healthcare Team looks forward to serving you.

For more information, contact:
The Littleton Group
Steve Streetman
sstreetman@littletongroup.com
Telephone: (512) 328-4447
Fax: (512) 328-2017