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    Beazley Remedy in Healthcare

    Regulatory liability

    Kelly Webster

    Kelly Webster

    Healthcare Management Liability FGL

    Beazley's Healthcare Regulatory product is designed to respond to actions brought by or on behalf of government entities for billing errors and omissions. Our policy also covers claims brought by commercial payors and defense expenses for formal voluntary disclosures to the government. Coverage includes attorney fees, external auditor and medical expert costs associated with defending these claims as well as fines and penalties and damages attributed at the time of settlement. Our reimbursement policy is available in all 50 states.

    Beazley does not require that insured's use panel firms but we do have experienced vetted counsel that can be recommended. Loss control services are also available to Beazley insureds with Beazley picking up a portion of the cost. Webinars are available free of charge on the latest regulatory topics to our partner brokers and clients.

    Claims Triggers

    Defense reimbursement and external forensic audit expenses, civil fines and penalties (where applicable) for various billing errors and omissions, as well as other regulatory violations including:

    • Medicare and Medicaid billing investigations
    • False Claims Act allegations
    • Commercial Payor actions
    • Anti-kickback statute violations
    • Stark Law violations
    • Qui Tam actions
    • Government or private contractor audits
    • Search warrants/subpoenas
    • Voluntary disclosure to a government entity

    Appetite

    Not for profit hospitals and health systems.  Not for profit medical clinics and long term care facilities. For profit physician groups. All risks with over $35,000,000 of revenue annually.

    Specifications

    • Up to $20,000,000 in Limits
    • Minimum retention of $250,000
    • Minimum of 10% coinsurance  
    • Optional retroactive buy back coverage for up to 3 years

    Key territories

    • US 50 States
    • Non-admitted or Admitted

    Not covered

    Business disputes, restitution, disgorgement, criminal actions, costs associated with implementing a corporate integrity agreement, moral hazards knows losses or circumstances, internal costs for auditors and coders.

    Thought Leadership

    Healthcare Regulatory Liability: Insurers Step up to the Plate

    Work Plan

    OIG Work Plan 2016
    http://oig.hhs.gov/reports-and-publications/archives/workplan/2016/oig-work-plan-2016.pdf

    OIG Work Plan 2015
    Office of Inspector General Activities

    Webinars

    Webinar: Healthcare Billing Investigations - Improving The Odds

    Webinar: The Decision to Disclose 

    Webinar: HIPPA Phase 2 Audits: What to expect and how to prepare 

    Healthcare Regulatory News Links

    Supreme Court Says the False Claims Act Isn't That Complicated

    U.S. Department of Health & Human Services, Office of  Inspector General - Semiannual Report to Congress

    Health-care fraud recoveries soar in 2016

    False Claims Act Penalties Set to Double, Far Exceeding Expected Increase 

    Beazley Expands Regulatory Liability Offering to Help Hospitals and other Healthcare Providers Manage and Mitigate Charges of Improper Billing

    Healthcare Fraud and Abuse Review 2015

    Staying Compliant: A Roadmap to Self-Disclosure

    CMS Issues Final Rule Governing the Return of Overpayments within 60 Days

    Gibson Dunn - Publications 2015 Year-End False Claims Act Update


    Staying Compliant

    Justice Department Recovers Over $3.5 Billion From False Claims Act Cases in Fiscal Year 2015

    The Definition of Identify: The 60-Day Rule

    Federal court sides with government in first interpretation of ACA's 60-day False Claims Act rule: takeaway for health systems

    SDNY Issues Groundbreaking Decision on False Claims Act Sixty-Day Rule 

    States push to recoup Medicaid money from questionable claims

    US regulators' healthcare fraud enforcement efforts continue unabated

    Lack of Materiality as a Defense in False Claims Act Cases

    2015 Mid-Year False Claims Act Update

    New OIG litigation team will tackle Medicare, Medicaid fraud cases

    Part Two of False Claims Act - the Basics Every Provider Should Know

    HHS Inspector General Issues Physician Compensation Medicare Fraud Alert

    The False Claims Act - the Basics Every Provider Should Know, Part One

    Blog: Expansion of State False Claims Acts Continues

    Supreme Court decision in FCA case both a win, setback for health care providers

    Healthcare Fraud Initiatives in 2015

    Department of Justice Pursuing Therapy Providers Under the False Claims Act

    Health Care Qui Tam Update and Recently Unsealed Whistleblower Cases

    HHS OIG and Industry Leaders Release Joint Guidance for Health Care Boards 

    Health-Care Fraud and Abuse: Implications for Oncology 

    There's a code for that: Doctors brace for 155,000 choices to explain medical issues 

    Spotlight on Unnecessary Care Likely to Get Brighter

    FCA Whistleblower Litigation Remains a Potent Threat to Health Care Providers --False Claims Act

    2014 Year-End FCA Update

    Government turns up the heat with the False Claims Act - 5 action steps for healthcare providers

    Justice Department Recovers Nearly $6 Billion from False Claims Act Cases in Fiscal Year 2014

    Balance needed in fighting health-care fraud 

    Florida Hospitals Face FCA Suit Over Kickback Scheme

    2014 Mid-Year False Claims Act Update

    Auditors: Texas must ramp up Medicaid anti-fraud efforts

    House panel seeks improved Medicare fraud efforts

    HEAT rises on healthcare fraud

    2013 Bass Berry & Sims Healthcare Fraud and Abuse Review

    Study: Half of U.S. Healthcare Providers 25% or Less Done With ICD-10 Implementation

    2013 Year-End False Claims Act Update

    Proposed Overpayment Reporting Requirements for MA and Part D Programs May Increase False Claims Act Liability 

    Government Intervenes in False Claims Lawsuit Against Ipc the Hospitalist Co. Inc. Alleging Overbilling of Physician Services 

    2013 on Track to Set Record for Health Care Fraud Recoveries Under False Claims Act 

    2013 Mid-Year False Claims Act Update 

    RAC medical record requests up 47% 

    Big names in health care audit released

    Georgia Hospitals Tangled Up in Kick Back Probe

    United States Intervenes In Health Care Fraud Action And Obtains $4 Million In Settlement 

    Fifty-Five Hospitals to Pay U.S. More Than $34 Million to Resolve False Claims Act Allegations Related to Kyphoplasty

    Policing of Medicare fraud explodes over two years

    States pressured to match their false claims acts to federal law

    Fight Against Medicare Fraud Costing Doctors And Hospitals Billions

    RACs reclaim $1.37B in overpayments as criticism mounts

    Stark Law, False Claims and HIPAA: Key Risk Areas for Hospitals 

    Ensign Group deal illustrates crackdown on healthcare fraud 

    California Rural Indian Health Board Inc. Settles False Claims Act Lawsuit

    Montana hospitals to pay $3.95M over referrals 

    CMS proposes more rewards for Medicare fraud whistleblowers 

    OIG Special Fraud Alert Labels Physician-Owned Distributorships (PODs) as "Inherently Suspect"

    April 17th release of OIG's Provider Self-Disclosure Protocol

    The Arrival of Meaningful Use Audits

    Providers struggle with the demands of the Medicare audit program and question the fairness of it all

    Recent Developments in False Claims Act Litigation

    Healthcare fraud cases yield $4.2 Billion

    Jury in nursing home whistleblower suit hands down $28 MILLION in fines

    Millions more could join Medicaid as Republican governors cave in



     

    Regulatory liability team

    Underwriters

    Scott Adams

    Underwriter - Healthcare

    Scott Adams

    Chicago, IL, USA

    +1 312 476 6271

    Carolyn Conners

    Healthcare Management Liability Underwriter

    Carolyn Conners

    Los Angeles, CA, USA

    +1 213 228 7708

    Edward Fedak

    Healthcare Management Liability Underwriter

    Edward Fedak

    Atlanta, GA, USA

    +1 770 351 1707

    Stavan Israel

    Underwriter Healthcare Management Liability

    Stavan Israel

    Chicago, IL, USA

    +1 312 476 6227

    Greg Staron

    Healthcare Management Liability Underwriter

    Greg Staron

    New York, NY, USA

    +1 646 378 4004

    Kelly Webster

    Healthcare Management Liability FGL

    Kelly Webster

    Chicago, IL, USA

    +1 312 476 6211

    Claims

    Rebecca Brenia

    Claims Manager

    Rebecca Brenia

    Farmington, CT, USA

    Steven Chang

    Claims Team Leader - Healthcare

    Steven Chang

    New York, NY, USA

    +1 646 943 5911

    Regulatory liability forms

    Product fact sheets

    Healthcare Regulatory Liability Fact Sheet

    The descriptions contained on this website are for preliminary informational purposes only. In the US, the product may be available on an admitted basis in some but not all jurisdictions through Beazley Insurance Company, Inc. In other US jurisdictions, the product is underwritten by Beazley syndicates at Lloyd's and is available only on a surplus lines basis through licensed surplus lines brokers. The publication and delivery of the information contained herein is not intended as a solicitation for the purchase of insurance on any US risk.

    Except where products are issued by Beazley Insurance Company, Inc., coverages are underwritten by Beazley syndicates at Lloyd's and will vary depending on individual country law requirements and may be unavailable in some countries.  The exact coverage afforded by the products described herein is subject to and governed by the terms and conditions of each policy issued.

    Some coverages are made available through Beazley USA Services, Inc., which is a service company that is a part of the Beazley Group and has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's syndicates 623 and 2623 which are managed by Beazley Furlonge Limited.  Beazley USA Services, Inc. is licensed and regulated by insurance regulatory authorities in the respective states of the US and transacts business in the State of California as Beazley Insurance Services (License#: 0G55497).