Medicaid Lien Resolution Fundamentals: What Every Trial Lawyer Needs to Know

If your client is on Medicaid and settles a personal injury case, you will almost always face a Medicaid lien. How you handle that lien directly affects your client’s net recovery, your professional liability, and your firm’s reputation. Yet many firms treat Medicaid lien resolution as an afterthought, and this is a costly mistake.

This post breaks down the federal framework, the three U.S. Supreme Court decisions controlling the analysis, and the practical steps you need to take to protect your clients.

How Medicaid Liens Work

Every state participating in the joint federal-state Medicaid program is required under Title XIX of the Social Security Act to have “third party liability” provisions. These provisions empower the state to seek reimbursement from liable third parties for injury-related medical costs paid on behalf of a Medicaid recipient.

Here is how this works in practice. When your client receives Medicaid-funded medical treatment for injuries caused by a third party, the state Medicaid agency acquires the right to recover those payments from any settlement, judgment, or award. Federal law at 42 U.S.C. 1396a(a)(25)(H) says the state is “considered to have acquired the rights of such individual to payment by any other party for such health care items or services.”

Your client, as a condition of Medicaid eligibility, has already assigned to the state the right to recover medical care payments from third parties. This assignment happens automatically. You do not need to consent, and your client has no ability to opt out.

The Federal Anti-Lien Statute: A Critical Limit

Federal law gives states recovery rights, but also imposes limits. The federal anti-lien statute at 42 U.S.C. 1396p(a)(1) prohibits any lien against a Medicaid recipient’s property prior to death on account of medical assistance paid. The federal anti-recovery statute at 1396p(b)(1) bars any adjustment or recovery of correctly paid medical assistance.

These two provisions create a tension with the third-party liability recovery statutes. The U.S. Supreme Court has addressed this tension three times over the past two decades, and each decision shapes how you resolve Medicaid liens today.

Ahlborn (2006): States Cannot Touch Non-Medical Damages

The first major decision came in Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268 (2006). Heidi Ahlborn was 19 years old when a car accident left her with a catastrophic brain injury. Medicaid paid $215,645.30 for her care. Her total damages were valued at approximately $3 million, but the case settled for roughly one-sixth of that amount.

Arkansas claimed the full $215,645.30 from the settlement. Ahlborn argued the state was entitled to recover only the portion of the settlement attributable to medical expenses.

The Supreme Court sided with Ahlborn unanimously. The Court held federal law authorizing state recovery from tort settlements is limited to the medical expense portion of a recovery. States are prohibited from forcing an assignment of, or placing a lien on, non-medical damages like pain and suffering, lost wages, or any other category beyond medical care.

For your practice, this means the state’s Medicaid lien does not attach to the entire settlement. The lien attaches only to the portion representing medical expenses.

The Pro-Rata Reduction Method

The Ahlborn decision gave rise to what is now called the “pro-rata” method for reducing Medicaid liens. The math works like this. If your client’s total damages are valued at $1 million and the case settles for $250,000, the settlement represents 25% of the total claim value. You apply that same 25% to the Medicaid lien to determine the state’s recovery.

The California Supreme Court confirmed this approach in Bolanos v. Superior Court, 87 Cal. Rptr. 3d 744 (2008). The court noted the U.S. Supreme Court’s approval of this formula in Ahlborn produced a “reliable result.”

This is one of the most effective tools you have for reducing a Medicaid lien. The key is building a strong total damages valuation. The higher the provable total damages relative to the settlement amount, the greater the reduction in the lien.

Wos (2013): No Arbitrary Allocation Formulas

After Ahlborn, some states revised their statutes and tried to set fixed percentages for recovery. North Carolina passed a law requiring up to one-third of any recovery be paid to Medicaid. No individualized allocation. No opportunity for the beneficiary to challenge the allocation.

The Supreme Court struck this down in Wos v. E.M.A., 133 S. Ct. 1391 (2013), in a 6-3 decision. The Court held North Carolina’s one-third formula was incompatible with federal law, which bars a state from demanding any portion of a beneficiary’s tort recovery except the share attributable to medical expenses.

The Court made two things clear. First, states are barred from using arbitrary, one-size-fits-all allocation formulas. Second, states must provide some procedure for beneficiaries to challenge the default allocation.

The Wos decision also reinforced: when a judicial finding, court decree, or stipulation allocates a settlement between medical and non-medical damages, the allocation controls. The anti-lien provision protects the non-medical portion.

Gallardo (2022): Future Medical Damages Are Now Fair Game

The most recent Supreme Court decision expanded the state’s recovery reach. In Gallardo v. Marstiller, 596 U.S. ___ (2022), the Court ruled 7-2: Florida Medicaid was permitted to recover its lien from all medical damages in a settlement, both past and future.

Before Gallardo, many practitioners read Ahlborn as limiting state recovery to past medical expenses only. The Gallardo decision changed this reading. The Court held the Medicaid Act’s assignment provisions require beneficiaries to assign rights to payment for medical care from third parties, and “medical care” includes future medical costs, not only those already paid by Medicaid.

This matters for your cases. When you do an Ahlborn pro-rata analysis after Gallardo, the denominator now includes both past and future medical damages. In cases with large life care plans, the lien reduction you expected before Gallardo will be smaller, or will disappear entirely.

Justice Sotomayor’s dissent raised the real-world consequence: injured clients will have fewer dollars available to fund special needs trusts protecting their eligibility for benefits Medicaid does not cover. The concern is valid, making your damages valuation work more important than ever.

What This Means for Your Practice

You need to apply the principles from all three decisions, Ahlborn, Wos, and Gallardo, to your state’s specific third-party liability recovery provisions. Every state’s statute is different, and the procedural requirements for challenging or allocating liens vary.

Here are the steps worth focusing on:

  • Build a strong total damages valuation early. The pro-rata reduction is only as effective as your ability to prove the full value of your client’s claim. Document all categories of damages thoroughly, including non-economic damages. This valuation is your primary tool for reducing the lien.
  • Know your state’s allocation procedures. After Wos, states must offer some mechanism for beneficiaries to challenge a default allocation. Some states have formal administrative processes. Others require court involvement. Learn the specific requirements in your jurisdiction before settlement.
  • Account for future medical damages. After Gallardo, the state’s recovery interest reaches into future medical expenses as part of the settlement. When building your damages model, give proper weight and documentation to non-economic damages. The higher the supportable value of non-economic damages relative to total damages, the better the pro-rata reduction.
  • Identify the Medicaid lien early. Contact the state Medicaid agency at the start of the case. Request periodic updates on Medicaid payments throughout the litigation. Liens discovered after settlement create leverage problems and delay disbursement.
  • Audit the lien carefully. Verify every charge on the Medicaid lien. Confirm each item relates to the injury at issue. Challenge charges that are unrelated or unsupported. This verification step alone often reduces the lien amount before you even get to the pro-rata analysis.

Why This Matters to Your Clients

Medicaid lien resolution directly controls how much of the settlement your client takes home. A poorly resolved lien eats into the recovery your client worked years to obtain. A well-resolved lien protects their financial interests and preserves funds for future care needs.

Clients who see too much of their settlement go to lien repayment leave frustrated and dissatisfied. That dissatisfaction affects your reputation and referral pipeline. Getting this right is good lawyering and good business.

The legal framework for Medicaid liens is complex, but the core principles are straightforward. States are limited to recovering from the medical expense portion of a settlement. The pro-rata method is your primary tool for reduction. And after Gallardo, future medical damages are part of the equation.

Synergy’s team resolves Medicaid liens across all 50 states, applying the Ahlborn, Wos, and Gallardo frameworks to protect client recoveries. If your firm handles personal injury cases involving Medicaid beneficiaries, getting expert support on lien resolution is one of the highest-value investments you will make.

Learn more at www.PartnerWithSynergy.com

Written by: Teresa Kenyon | Vice President of Lien Resolution at Synergy & Kevin James | Lien Resolution Strategy Coach at Synergy

Dustin Ruge – 80% of Legal Work Is Repetitive. AI Is Coming for All of It.

Dustin Ruge has spent over 17 years inside the legal industry. He co-founded Law Leaders and built Legal Navigator, one of the most advanced AI intake automation tools in the PI space. On a recent episode of Trial Lawyer View with host Jason Lazarus, Ruge made the case that we are living through the single largest disruption the legal profession has ever faced.

His reasoning is simple. About 80% of what goes into legal work is repetitive. If it is repetitive, it is automatable. And if it can be automated, someone is already building the tool to do it.  The firms that understand this will grow. The ones that do not will fall behind. There is no middle ground.

The Real Cost of Doing Things the Old Way

Here is what “business as usual” looks like in the PI industry right now.  Client acquisition costs have nearly doubled since COVID. Ruge’s team surveyed 1,200 small to mid-size law firms during regular business hours. They found that 35% did not answer their phones. Their estimated case value lost to unanswered calls: $109 billion.

Among the firms that did answer, the national conversion rate from contact to signed case sits at roughly 7%. That is one-third of the average across almost every other industry in the country. Another $200 billion in inefficiency.

The firms stuck on legacy processes are hemorrhaging value at every stage. Not because they lack leads, but because their systems fail to convert the leads they already have.  Technology is the only path to closing that gap.

Why “Buying AI” Is Not a Strategy

There is a temptation to treat AI like a shortcut. Buy the tool, plug it in, see results. Ruge warns against this. Buying AI without a strategy, he says, is like hiring staff without a job description.

Every firm runs on three things: people, time, and money. If AI does not improve at least one of those, it adds complexity without adding value.

Before evaluating any tool, you need answers to two questions:

– What specific outcome are you trying to achieve, and by when?

– Where are your biggest inefficiencies measured in time, revenue, and productivity?

Once you have those answers, AI falls into one of three deployment categories:

1.      Add. You gain a capability you do not currently have. A solo attorney without a full-time receptionist brings in an AI intake agent and now has 24/7 coverage.

2.      Replace. A function is underperforming or a role is opening up. AI fills the gap with more consistency and lower cost.

3.      Augment. Your existing process works but slows down at volume. A workers’ comp firm asking the same 17 intake questions 50 to 100 times a day hands that repetition to AI and frees up staff for higher-value work.

This framework, add, replace, or augment, gives firm leaders clarity on what they are buying, why they are buying it, and how to measure whether it works.

Intake and Case Generation Are Being Rebuilt from the Ground Up

The market is shifting from lead generation to case generation. The distinction matters. Leads are contacts. Cases are signed clients. And the distance between those two points is where most firms lose money.

Ruge built Legal Navigator to solve this problem. The system handles inbound calls, pre-qualifies leads, enriches case data, schedules appointments, and routes qualified cases to attorneys before a human touches anything. It also runs outbound sequences. When a form-based lead comes in, the system contacts the prospect across multiple channels within seconds.

Speed to lead is the critical metric. Every minute a submitted form sits without action, the value of that potential case drops. Prospects shop around. Ruge’s system eliminates that delay.

The result: firms are increasing their return on advertising spend without spending a single additional dollar. They are extracting more signed cases from the same lead flow by being faster and more consistent at the point of intake.

Ruge predicts that the entire front office of a PI firm will be fully automated within the next few years. From the first call through case qualification to agreement signing, every step will run on decision-based workflows, not individual staff judgment.

That is a structural change. Firms that adapt to it will scale faster. Firms that resist it will watch their cost per case climb until the economics break.

The Legal Tech Ecosystem Needs Collaboration, Not Silos

The pace of innovation in legal tech is moving too fast for any single vendor to own the entire workflow. Ruge is direct about this: betting on one vendor to do everything is a mistake.

Most legal tech tools today operate in silos. They do not communicate with each other. When a new tool appears, it takes months, sometimes over half a year, for the company to build integrations into existing case management systems. That delay costs firms time and competitive position.

This is why Ruge’s team built LawLink, an API-driven integration layer designed to connect the fragmented legal tech market into one operating ecosystem. A new technology company calls LawLink and gets connected to the legal ecosystem in days, not months. The engineering cost and redundancy of building individual integrations disappears.

For firms, the benefit is direct. You get access to the latest tools faster. You do not wait six months for a promising new product to sync with your case management system. The firms that adopt new technology first gain a measurable competitive edge. An integration layer that collapses time-to-deployment changes the game entirely.

Ruge sees the future of legal tech as collaborative, not proprietary. The winners will be the platforms that connect the ecosystem, not the ones that try to wall it off.

ABS and MSO Models Are Rewriting the Rules of Ownership

Two structural changes are reshaping how PI firms are owned, operated, and valued.

Alternative Business Structures (ABS) allow non-attorney investors to own parts of a law firm. Arizona led the full implementation. Washington, D.C. and Puerto Rico have adopted elements of it. The effect: outside capital is flowing into what was historically a closed financial system.

Management Service Organizations (MSOs) separate the business of law from the practice of law. The concept is borrowed from healthcare, where Dental Service Organizations (DSOs) already handle operations while dentists focus on clinical work. Under an MSO model, the business side, staffing, technology, marketing, compliance, runs independently from the legal practice itself.

Both models are attracting investors who think in terms of scalability and systems. They are not buying your reputation or your open cases. They are looking for repeatable processes that function independently of any single person.

Ruge introduces the concept of “technology debt.” It is the gap between where your systems are today and where they need to be for an investor or acquirer to see value. The diagnostic question is straightforward: does your firm run without you?  If the answer is no, you have technology debt. And that debt directly suppresses your exit valuation.

Firms that build with this mindset from the start, investing in automation, documented workflows, and system-driven operations, will sell at multiples that reward scale. Firms that operate out of the founder’s head will sell for a fraction of what they could have been worth.

The time to address technology debt is five to ten years before you want to exit. Not the months before.

Bottom Line: The Mindset Change That Separates Winners from Everyone Else

Attorneys are trained to practice law. Law school teaches nothing about running a business. That gap has always existed. What has changed is the penalty for ignoring it.

Ruge’s advice to firm leaders: stop operating and start architecting. The winners in the next three to five years will not be the best litigators. They will be the best business architects, the ones who design systems, deploy technology with intention, and build firms that function without their daily involvement.

He references Michael Gerber’s E-Myth framework. Systems run businesses. People run systems. You need to spend as much time working on the business as you do in it.

Strategy comes before software. Always. If you have not identified your problems, set measurable goals, and designed for scale, plugging in an AI tool will not fix anything. It will add cost and confusion on top of an already broken process.

The firms that will thrive in this new environment share a few traits. They treat technology as a core operating function, not an experiment. They measure AI against their existing processes, not against an imaginary standard of perfection. They build systems that are scalable, repeatable, and independent of any single person.

Ruge’s closing point on the show captures the moment plainly: “If you are not ready for change, change is ready for you.”

The disruption is here. The economics of running a PI firm are shifting underneath every practice in the country. The firms that recognize this and act on it will grow. The ones that wait will find the market has moved on without them.

🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://triallawyerview.com/podcast/dustin-ruge/

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how synergy. can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries.  Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution.  Learn more at: https://partnerwithsynergy.com/liens/

The 5 Discovery Requests That Force Insurers to Reveal Their AI Valuation Models

In a previous post, I wrote about how insurance carriers are using AI to value your clients’ personal injury claims. Knowing the threat exists is one thing. Having the tools to fight back is another. So this is the tactical follow-up. These are five specific discovery requests you should be including in every case where you suspect an algorithm played a role in how the carrier valued your client’s claim. I’ve been discussing these approaches on Trial Lawyer View, and the feedback from lawyers who have used them has been encouraging.

A federal court in Minnesota recently validated this entire approach. In The Estate of Gene B. Lokken v. UnitedHealth Group, Inc., No. 23-CV-3514 (D. Minn.), the court granted a motion to compel discovery into an insurer’s use of an AI program to evaluate claims. The court found the plaintiffs were entitled to documents showing how the program works, its development goals, and whether the AI was designed to replace physician decision-making. That ruling changes the calculus for every PI lawyer in the country.

Let me walk you through the five requests and why each one matters.

1. The Algorithm Itself: Request the Claims Valuation Software and Its Logic

Your first request should target the software or AI tool the carrier used to evaluate your client’s claim. Request all documents, manuals, training materials, and technical specifications related to any software, algorithm, or artificial intelligence system used to evaluate, value, or make recommendations on bodily injury claims, including Colossus, ClaimIQ, Guidewire, or any proprietary system.

Why this matters: Over 70% of major carriers use Colossus or similar claim valuation software. These programs convert your client’s medical records into numerical “severity points” and spit out a settlement range. The adjuster’s hands are often tied to whatever number the algorithm produces. You need to know what system was used, how the system assigns value, and what rules govern the output.

Carriers will resist this request. They will claim the software is proprietary and constitutes a trade secret. Push back hard. The Lokken court rejected similar objections and ordered production of documents related to AI development goals and function. You are not asking for their source code. You are asking how decisions about your client’s case were made. That is squarely within the scope of discovery.

2. The Inputs: Request All Data Entered Into the System for Your Client’s Claim

Request production of all data, codes, classifications, severity ratings, value drivers, and inputs entered into any claims valuation software in connection with the evaluation of claimant’s bodily injury claim, including all screen captures, printouts, reports, and output generated by the system.

Why this matters: The output of these systems is only as good as what goes in. Adjusters enter ICD-10 diagnostic codes, treatment types, and duration data. They also enter subjective assessments about things like “duties under duress,” which is Colossus terminology for how your client’s daily life has been affected. If the adjuster fails to input a symptom or undervalues a diagnosis, the algorithm produces a lower number. That lower number becomes the carrier’s settlement authority.

This request exposes whether the adjuster accurately represented your client’s injuries to the system. If the adjuster left out key information, you now have evidence of bad faith.

3. The Adjuster’s Authority: Request Documents Showing the Relationship Between AI Output and Settlement Authority

Request all documents, policies, procedures, memoranda, and training materials that describe the relationship between the output of any claims valuation software and the settlement authority granted to the adjuster handling claimant’s claim, including any policies regarding whether and to what extent the adjuster is permitted to deviate from the software’s recommended range.

Why this matters: The insurance industry tells anyone who will listen that Colossus and similar tools are advisory. They say the software output is a starting point, and adjusters have discretion to go higher when the facts warrant. In practice, that is rarely true. A former Farmers Insurance employee who became a consultant for plaintiffs’ lawyers has estimated that carriers save 15% to 30% on injury claim payouts by using these systems. Those savings only happen when adjusters follow the algorithm.

If you obtain internal policies showing that the adjuster had little or no authority to exceed the software’s range, you have a strong bad faith argument. You are proving that the carrier did not individually evaluate your client’s claim on its merits. Instead, the carrier delegated that evaluation to a machine and locked the adjuster into whatever the machine produced.

4. The Calibration Data: Request How the Carrier Tuned the Algorithm’s Settlement Values

Request all documents related to the calibration, configuration, updating, or modification of any claims valuation software used by carrier, including all decisions to adjust severity point values, dollar-per-point multipliers, or settlement ranges for the jurisdiction and time period applicable to claimant’s claim.

Why this matters: These systems are not static. Carriers periodically adjust the dollar values assigned to each severity point. They calibrate based on local settlement data, jury verdicts, and their own loss experience.

Here is the concern. If a carrier calibrates the algorithm to reflect below-market values, every claim processed through that system gets undervalued. This is not an accident. This is a business decision to systematically suppress claim values across an entire book of business. Your discovery request forces the carrier to show you the numbers behind the numbers. If the calibration data shows that the carrier set its multipliers below the range of recent jury verdicts in your jurisdiction, you have evidence that the system was designed to produce lowball results.

5. The Oversight Record: Request All Policies and Audits Governing AI Use in Claims

Request all documents related to carrier’s policies, procedures, audits, or oversight of the use of artificial intelligence or claims valuation software in the evaluation of bodily injury claims, including any internal or government investigations into the accuracy, fairness, or bias of such systems, and any employee training materials related to the use of AI in the claims process.

Why this matters: The Lokken court specifically allowed discovery into both the insurer’s oversight of AI and government investigations into the insurer’s use of AI. This is important because insurers have a duty to fairly evaluate every claim on its individual merits. If a carrier adopted AI and failed to audit the system for accuracy or bias, that failure is evidence that the carrier did not act in good faith.

There is also a growing body of regulatory interest in this area. Several state insurance departments have begun examining whether AI-driven claims processes comply with consumer protection laws. If the carrier has been the subject of a regulatory inquiry, you want those documents. They tell you what the regulator was concerned about, and they give you a roadmap for your own bad faith case.

Putting These Requests to Work

Start including these five categories in your standard discovery template for every PI case against a major carrier. Do not wait until you suspect AI involvement. Assume the algorithm is there. More than 70% of major carriers use some form of claims valuation software. The question is not whether a computer played a role. The question is how much of a role the computer played.

When the carrier objects, and they will, cite the Lokken decision. Point to the court’s finding that plaintiffs are entitled to know how the AI works, what its development goals were, and whether the system was designed to replace human decision-making. Frame your argument around the carrier’s obligation to evaluate each claim on its individual merits. If the carrier outsourced that obligation to a machine, you have a right to know.

Deposition strategy matters here too. When you depose the adjuster, ask whether they used any software to evaluate the claim. Ask what data they entered. Ask whether they had authority to exceed the software’s range. Ask whether they did exceed the range. These questions build the record you need to make your bad faith case.

The Bigger Picture for Your Practice

This is not about being anti-technology. AI is going to play an increasing role in claims handling, and that is not going to change. The issue is transparency and accountability. When a carrier uses a machine to value your client’s pain and suffering, your client has a right to know. And you, as their lawyer, have an obligation to find out.

I have spent over two decades working on the resolution side of catastrophic personal injury cases. I have seen how carriers evaluate claims from the inside. What I know is this: the carriers who are investing in AI are not doing so to be more fair. They are doing so to be more profitable.

The carriers are not going to stop using AI. But they should expect that you are going to start asking questions about how they use it.

Why Synergy is the Answer to Help You Scale

Synergy exists to help firms confront the operational realities being driven by technology and scaling pressure. By removing administrative burdens related to lien identification, verification and resolution, from your staff, we help you strengthen your practice’s capacity for high-value legal work and sustainable growth.

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how Synergy can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries.  Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution.  Learn more at: https://partnerwithsynergy.com/liens/

CMS Is Testing AI on Medicare Claims. Here Is Why That Should Concern Every Personal Injury Firm Who Settles Cases for Medicare Beneficiaries.

For over two decades, the Medicare Secondary Payer Act has been the source of more confusion, frustration, and regulatory concern than just about any other issue personal injury firms face at settlement. As an industry commentator and someone with a professional Medicare certification, I have lived through every twist and turn of it. The Advanced Notices of Proposed Rulemaking that went nowhere. The mandatory insurer reporting under MMSEA Section 111 that kicked in back in 2010. The Stallcup memo in 2011 that created a firestorm and then faded. Multiple attempts at formal rulemaking, all withdrawn without explanation.

Through all of that, one thing stayed constant. Medicare’s enforcement of its future interest protections remained, to be blunt, limited. The government simply did not have the bandwidth to chase down every settlement involving a Medicare beneficiary and connect the dots between injury-related treatment paid for after a case resolved and the settlement itself. Not across fifty states. Not across hundreds of millions of settlements spanning decades. Not with a patchwork quilt of inconsistent damages laws, caps, and reporting requirements.

That reality shaped how I have counseled clients for years. At the close of every case involving a Medicare beneficiary, or someone who may become one within thirty months, I sit down and walk them through what happens next. I explain how Medicare might deny their future injury-related treatment. I explain that if Medicare pays for care connected to the settlement, it could deny future care.

I have also been honest with clients about the practical likelihood of Medicare actually catching up to them. With limited staff and resources to sift through mountains of medical and billing records to connect the dots, the statistical odds of enforcement were, historically, low. Not zero. But low. I always told clients to be prepared. Just not panicked.

That calculus may be about to change. And change fast.

CMS Is Now Deploying AI on Medicare Claims

In January 2026, the Centers for Medicare and Medicaid Services launched a pilot program called the Wasteful and Inappropriate Service Reduction Model, or WISeR. It is running in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The program runs through 2031.

Here is what WISeR does. It uses artificial intelligence and machine learning to evaluate prior authorization requests for certain Medicare services. Doctors in those six states now have to get AI-backed approval before providing specific types of care under traditional fee-for-service Medicare. This is a first. Prior authorization has never been a standard feature of original Medicare. It has been common in Medicare Advantage, but not in the traditional program.

The stated goal is to reduce waste and cut down on low-value services. CMS says the program targets treatments with limited clinical benefit, things like certain skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for osteoarthritis. Six private technology companies are participating as model contractors. They include Cohere Health, Genzeon Corporation, Humata Health, Innovaccer, Virtix Health, and Zyter.

The program is already drawing fire. The Electronic Frontier Foundation filed a FOIA lawsuit against CMS in late March 2026, alleging the agency has refused to turn over basic records about how the AI works, what data trained the models, and what safeguards exist against bias. Early results out of Texas are not encouraging. Only 62% of prior authorization requests were initially approved by the AI. That number rose to 84% once a human reviewed them. Nationwide, 92% of prior authorization requests in Medicare Advantage are fully or partially approved. The gap is significant.

Perhaps most concerning is the financial incentive structure. The vendor companies participating in WISeR are compensated, in part, based on the savings they generate from denied or averted claims. According to the EFF, vendors can receive up to 20% of the expenditures associated with care they deny. That is a structure that rewards saying no.

Why This Matters for Personal Injury Firms

Now let me explain why I think WISeR, or something very much like it, should be on the radar of every personal injury firm in the country.

WISeR itself is focused on prior authorization. It is not, today, a tool for tracking settlements or pursuing reimbursement of conditional payments. But what it represents is far more important than its current scope. It represents CMS embracing AI as a tool to monitor, evaluate, and act on Medicare claims data at scale. That is the real headline here.

Think about what has historically protected clients from aggressive Medicare enforcement after settlement. It was not the law. The law has always been clear. Under the MSP, Medicare’s position as secondary payer means that if a settlement includes damages for future medical care, the burden to pay for future care should not be shifted to Medicare. CMS has been consistent on that point for years, even as the regulatory landscape around set-asides has remained undefined.

What protected clients was the practical reality of enforcement. Medicare could not hire enough people to comb through the massive universe of medical records, billing data, settlement reports, and treatment histories to figure out which beneficiaries received injury-related care after settling a case and failed to reimburse Medicare or failed to set aside funds appropriately. The data existed. The ability to process it did not.

AI changes that equation.

The Safari Into the Black Hole

Imagine for a moment that CMS applies the same kind of AI capability it is testing with WISeR to its MSP enforcement. Instead of using AI to gatekeep prior authorizations, picture it sifting through the MMSEA Section 111 mandatory insurer reporting data, cross-referencing it with post-settlement medical claims, identifying patterns of injury-related treatment paid for by Medicare after a case was resolved, and flagging those cases for recovery action.

This is not science fiction. The data is already there. Since 2010, every settlement involving a Medicare beneficiary of $750 or more has been reported to Medicare. Medicare already has the settlement data. It already has the claims data. What it has never had, until now, is a tool sophisticated enough to connect the two at scale.

If CMS deploys AI to launch that safari into the black hole of past and present records, the results could be dramatic. We are talking about the potential to identify reimbursement opportunities in settlements completed years ago. And when the federal government smells easy money, it gets motivated. History tells us that much.

The MSP’s private cause of action for double damages makes this even more urgent. We have already seen Medicare Advantage plans use the double damages provision aggressively. MSP entities have built an entire business model around data mining and demanding payment under the MSP. A 2026 industry forecast predicted increased activity from these entities, not less. Now imagine the federal government itself armed with AI to do the same thing, but with the full weight of the Department of Treasury behind it, including the ability to offset tax refunds and Social Security payments.

What This Means for Your Practice Right Now

I want to be clear. I am not predicting that CMS will announce an AI-powered MSP enforcement program tomorrow. But I am telling you that the building blocks are now in place. CMS has shown it is willing to hand AI tools to private vendors and incentivize them financially. It has shown it is willing to apply those tools to Medicare claims processing. The step from prior authorization review to settlement recovery analysis is not a large one technically. It is a matter of will and budget, and the federal government has both when it comes to protecting the Medicare Trust Fund.

So what should you be doing right now?

First, take MSP compliance seriously at every stage of the case. This is not new advice. But the risk of cutting corners is growing. Identify Medicare beneficiaries and those approaching eligibility early. Do it at intake and do it again before disbursement. Document everything.

Second, educate your clients thoroughly at settlement. Every client who is on Medicare or will be within thirty months needs to understand what happens with their future medical treatment. They need to know that Medicare can deny care. They need to understand the risks of not setting aside funds appropriately. And they need that explanation documented in the file.

Third, do not assume that low enforcement odds from the past will hold in the future. The landscape is shifting. CMS is investing in technology. Private recovery entities are becoming more aggressive. The combination of mandatory insurer reporting data, AI, and financial incentives to recover funds creates a very different risk profile than what we have seen over the last two decades.

Fourth, watch the WISeR program closely. The EFF lawsuit may force some transparency about how the AI models work, what data they use, and what safeguards are in place. That information will be valuable for understanding what CMS is capable of and where it is heading.

Fifth, consider how AI could be used offensively on behalf of your clients. If insurers and CMS are deploying AI, plaintiff firms need to understand these tools too. You should be thinking about how to use discovery to expose algorithmic decision-making in claims handling. Several carriers are already facing lawsuits for using AI to improperly deny claims in Medicare Advantage. The same types of challenges may become relevant in the MSP context.

The Bigger Picture

The Medicare Secondary Payer Act has always been, as the Eleventh Circuit put it, “notoriously complex.” For most of the last twenty-plus years, that complexity was matched by enforcement that was inconsistent, underfunded, and slow. Personal injury firms could afford to treat MSP compliance as something between an annoyance and a genuine risk, depending on the size of the case and the client’s Medicare status.

Those days are ending. The government is getting smarter. Literally. AI gives CMS the potential to do what it has always had the legal authority to do but lacked the practical capacity to accomplish, which is to systematically identify and pursue reimbursement on settlements where Medicare’s interests were not adequately protected.

For personal injury firms, this is not a reason to panic. It is a reason to prepare. Build your compliance processes now. Educate your clients. Work with qualified MSP compliance professionals. And keep your eyes open, because the rules of engagement in this space are about to change in ways we have not seen since MMSEA was passed in 2007.

The quiet period is over. Medicare just got smarter. Your practice needs to be smarter too.

Scale Your Practice with Synergy

Synergy exists to help firms confront the operational realities being driven by technology and scaling pressure. By removing administrative burdens related to Medicare compliance, lien identification, verification and resolution, from legal teams, we help personal injury firms strengthen their practice’s capacity for high-value legal work and sustainable growth.

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how synergy. can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries.  Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution.  Learn more at: https://partnerwithsynergy.com/liens/

Medicare Final Demand Isn’t the End of the Line

When a Medicare Final Demand arrives in the mail or your inbox, the clock starts ticking. Under the Medicare Secondary Payer recovery process, payment must be made within 60 days of the Final Demand letter to avoid interest on the outstanding balance. For many personal injury firms, that deadline creates urgency.  If payment is not made within that window, the debt becomes delinquent and interest begins accruing. 150 days after the Final Demand is issued, continued non-payment can trigger additional collection efforts, including referral of the debt to the U.S. Department of the Treasury for collection actions. 

Once the Final Demand is issued, attorneys have two potential paths: 

  1. The Appeals Route

The traditional route is the Medicare administrative appeals process. Appeals move through multiple administrative levels before federal court review is even available, which can take months or years. Meanwhile, interest can continue to accrue on unpaid balances if the demand is not satisfied. For many cases, this path is impractical. 

  1. The Post-Payment Relief Route

The alternative strategy is to pay the Final Demand and then pursue post-payment relief through waiver or compromise requests. These requests focus less on technical billing disputes and more on equitable considerations, such as hardship, collectability, or fairness in the recovery process. 

For many attorneys, the Final Demand feels like the end of the Medicare process. It shouldn’t be. In reality, it can be the beginning of an opportunity to improve the client’s financial outcome through the compromise/waiver process. 

The Overlooked Strategy 

A key point many attorneys miss is this: 

A Final Demand does not necessarily mean Medicare’s recovery amount is final. You can still request a Medicare compromise or waiver after the Final Demand is paid. 

In fact, many practitioners intentionally pay the Final Demand within the 60-day window first to stop interest exposure and protect the firm and client from enforcement risk. Once payment is made, a compromise or waiver request can be submitted.  

Here’s the strategy: 

Step 1: Pay the Final Demand within 60 days to stop interest and eliminate enforcement risk. 
Step 2: Submit a post-payment compromise or waiver request. 
Step 3: If approved, Medicare refunds part of what you paid. 

The Result: A Possible Refund to Your Client! 

Three Legal Paths to Reduce Medicare’s Claim 

Once the Final Demand has been paid, there are three primary legal avenues to request a reduction of Medicare’s recovery amount. Not all cases will meet the criteria but nonetheless should be considered as a possibility. 

  1. Financial Hardship Waiver

Authority: Section 1870(c) of the Social Security Act 

These requests are typically reviewed through Medicare’s recovery contractor, BCRC and apply when repayment would create financial hardship for the beneficiary. 

  1. Best Interest of the Program Waiver

Authority: Section 1862(b) of the Social Security Act 

CMS may waive repayment when doing so is determined to be in the best interest of the Medicare program. These decisions are discretionary and are often based on broader policy or fairness considerations.  

  1. Federal Claims Collection Act Compromise

Under the Federal Claims Collection Act, the federal government has authority to compromise claims for less than the full amount owed when collection of the full debt may be difficult or inefficient.  

Compromise requests often focus on: 

  • Collectability of the debt 
  • Litigation risk 
  • The cost of pursuing full recovery 

In many cases, multiple reduction paths can be pursued simultaneously, increasing the chances that Medicare will reduce the claim. If approved, Medicare will issue a refund of part or all of the amount previously paid. 

Why You Should Be Using This Strategy 

For the injured party, Medicare reimbursement can feel confusing and frustrating. After waiting months or years for their settlement, they often see a significant portion of the recovery earmarked for lien repayment.  This is especially so for cases where there are liability issues; high medical expenses; or significant Medicare payments. 

Medicare’s repayment formula can dramatically reduce the client’s net recovery. Post-payment waiver and compromise requests provide a second chance to improve the outcome. For the injured party, that refund can make the difference between a disappointing result and a settlement that actually helps them move forward. 

Where This Fits in Modern Lien Resolution 

Healthcare lien resolution is becoming more technical and more aggressive. Medicare, in particular, operates under the Medicare Secondary Payer (MSP) statute, which gives the government strong enforcement tools and significant resources to pursue repayment when another party is responsible for medical costs. Because of this, firms must balance two priorities: 

  • Strict Medicare compliance 
  • Maximizing the client’s net recovery 

Post-payment waiver and compromise requests accomplish both. They allow your firm to: 

  • Stop interest and enforcement risk 
  • Maintain compliance with MSP obligations 
  • Pursue additional reductions after payment 

Adding this step to your lien resolution workflow is a simple change with potentially significant impact. 

Bottom Line 

You do not have to choose between Medicare compliance and maximizing your client’s recovery. The strategy is straightforward: 

  1. Pay the Final Demand within 60 days. 
  1. Assess the likelihood of a successful result and if so, submit waiver and compromise requests after payment. 
  1. Seek a refund that increases the client’s net settlement. 

For personal injury firms handling Medicare liens, this post-payment strategy can protect your practice, strengthen client relationships, and deliver better outcomes. If you are not considering this approach yet, you may be leaving meaningful value on the table for both your clients and your firm. 

Synergy’s team of experts assists with these strategies every day.  In the last 12 months, we have a 73% success rate with compromise/waiver requests and an average refund of over $26k.  If you aren’t achieving this kind of success rate, partner with Synergy for Medicare compliance and let us secure a compromise/waiver for your client.   

Written by: Teresa Kenyon | Vice President of Lien Resolution at Synergy & Jasmine Patel | Medicare Lien Resolution Specialist

Eric Sanchez – Your PI Firm Doesn’t Have an AI Problem. It Has a Process Problem.

Why Most Firms Get AI Adoption Wrong

I sat down recently with Eric Sanchez of Maestro Strategic Partners on the Trial Lawyer View by Synergy podcast to talk about AI adoption in personal injury firms. Eric is a legal technologist who works with plaintiff firms on operations, technology implementation, and leadership. He has been in the legal tech space for years, and he sees more law firms from the inside than most of us will in a career.

The conversation went places I did not expect. And the takeaway I kept coming back to after we wrapped was this: most firms that struggle with AI do not have a technology problem. They have a process problem. They have a people problem. And until they address those first, the AI tools will not save them.

AI Is No Longer Optional

Eric was blunt about where we are. AI adoption in law firms is not a preference anymore. It is a requirement to compete. The speed of change in AI makes it different from every other technological shift we have seen. Eric pointed out that AI is advancing every six to seven months in ways that took other technologies years. If you have not started adopting it, you are falling further behind with each passing quarter.

He referenced firms like Sweet James that have been building AI into their operations for two years. They are operating on a different level than firms still debating whether to buy their first tool. And the gap between the two grows wider every month.

The consumer side of this matters too. Your clients are already using AI for everyday tasks. They are using it to find recipes, troubleshoot appliances, and plan trips. That normalizes it. Your staff use it at home whether you know it or not. So, the stigma around AI is fading at the ground level, which means the appetite for it inside your firm is higher than you think.

People, Process, Technology. In That Order.

Eric laid out a framework I think every firm leader needs to hear. There are three legs to success with AI: people, process, and technology. And the order matters.

Most firms go straight to the technology. They buy a tool. They roll it out. They wonder why nobody uses it. The reason is simple. You skipped the first two steps.

Start with process. Eric told me the number one problem he sees is that firms have not codified their own workflows. If you have six paralegals and each one orders medical records differently, you do not have one problem to solve with AI. You have six. Before you bring in any tool, figure out what your people are doing now, identify what works, and lock it down as the standard. Then bring in technology to improve that standard.

Next, address your people. Eric described four personas that exist in every firm. There is the visionary, usually the firm principal, who wants to grow and innovate. There is the champion who is excited about new tools. There is the blocker, often the tenured paralegal who resists change. And there is the middle-of-the-road person who wants to get their work done with as little friction as possible.

Each persona requires a different approach. The visionary sometimes needs to be reeled in. The champion needs to be grounded in practical concerns. The blocker needs to be managed carefully. And Eric made an important point here: people do not hate change. They hate change that does not benefit them. If your team understands how a new tool makes their work easier or more effective, they will get on board.

Start with the Pain Points Your Team Already Feels

Eric recommends creating work groups within your firm to identify pain points from the ground up. Not top down. When product selection happens at the top without input from the people doing the work, you get low adoption every time.

He gave a good example. Ask your paralegals to rate opening insurance claims on a scale of one to ten. He said he has never met a paralegal who rates that above a three. That is where you start. Find the tasks your team dreads, the ones that eat up time without adding value, and look for AI solutions there first.

Lien verification is another one. Medical record retrieval. Treatment follow-up calls. These are high-volume, low-satisfaction tasks where the right tool gives you immediate leverage. And when your staff has identified the pain point themselves, the buy-in is already there.

Eric also made a point I agree with fully. If you find a solution that handles eighty percent of the problem, that is a win. Lawyers tend to focus on the outliers, the edge cases where the tool falls short. But if you are solving the bulk of the workload, you are ahead of most firms.

You Need an AI Policy Before You Need an AI Tool

This was one of the most practical pieces of advice from the conversation. Before you buy anything, write an AI policy for your firm. Eric pointed out that if you have twenty people in your office, some of them are already using public AI tools for work. They are pasting case details into ChatGPT. They are uploading documents to free tools without understanding the privacy implications.

An AI policy does not have to be complicated. At minimum, it should cover what tools are approved for use, what information is off-limits for public AI platforms, and what protections need to be in place around personally identifiable information. That is a quick, low-cost way to create a baseline of protection for your firm.

There Is No Single AI Tool That Solves Everything

One of the more interesting parts of our conversation was about tech stacks. Eric was clear that a single all-in-one AI platform is not the answer for most firms. The reality is that different tools do different things well. You might need one tool for medical chronologies, a different one for case valuation, another for marketing, and yet another for telephony and client communication.

Eric thinks the market will split into two camps. Some firms will go all-in on a single platform that handles intake, case management, and AI together. Others will keep their existing case management system and build a specialized tech stack around it with best-in-class tools for each function.

Neither approach is wrong. But the choice depends on your firm, your workflows, and your tolerance for managing multiple systems. A firm that litigates five percent of its cases has different needs than a firm that litigates forty percent. A high-volume TV advertising firm has different pricing sensitivities than a boutique trial firm handling high-value cases.

Eric also raised an important concern about the economics of legal AI. We are seeing staggering valuations and massive investment into these companies. Investors expect a ten-times return. At some point, the math will not work. That is worth thinking about when you are choosing which platforms to build your practice around.

AI Should Complement Your Team, Not Replace Them

I have been through a personal injury case myself. It is intensely personal. There is no place for AI to replace the human touch in client-facing interactions, especially during the most vulnerable moments of a case.

Eric shared a story that made this concrete. He tested a voice AI intake agent by pretending to be a prospective client. When he said he had lost his arm, the AI responded by asking if he had sought treatment. It completely missed the weight of what he had said. That kind of response puts your firm at the back of the line for any client paying attention.

The right approach is to use AI to support your people, not to stand in for them. Eric described a better application: using AI to create personalized video check-ins for clients, based on the lawyer’s own voice and likeness, with a clear option to connect with a real person. That adds value without removing the human connection.

He was direct about the workforce implications too. If AI is going to reduce your headcount, be honest with your team about that. The moment you start making cuts without being upfront, your best people, the ones with options, will leave. They will not wait to find out if they are next. Transparency builds trust. And the people who stay and learn to work alongside AI will become more valuable than ever.

Agentic AI Is Not the Same as Automation

Eric drew an important distinction between basic automation and agentic AI. A lot of what firms call AI today is not AI at all. It is an if-then automation. Zapier zaps, workflow triggers, rules-based routing. Those are useful, but they are not intelligent.

Agentic AI is different. An AI agent recognizes an event, makes a determination on its own, and executes. Eric compared it to the difference between “lawyer” as a label and the specific kind of law you practice. Agentic AI is a broad category. Some agents research and compile information. Some make phone calls to schedule appointments. Some monitor metrics and reallocate marketing spend without being told.

The AI-enabled firm of the near future will have paralegals operating like piano players, with each key being a different agent. They will manage workflows by launching agents to handle discrete tasks. That requires a new level of skill and sophistication from your team, which is another reason the people side of this equation matters so much.

What the AI-Enabled Firm Looks Like

Eric sees consolidation ahead. Firms that did not adopt AI will not be able to compete for cases. They will be absorbed by firms that did. The firms at the top will not be using a single AI tool. They will have built specialized tech stacks with tools for every function, from intake to litigation to marketing to client communication.

Those firms will respond to new mass tort opportunities in hours, not days. They will have agents monitoring case metrics and adjusting strategies in real time. They will compete for talent differently because the people who know how to work with AI will be in high demand.

Eric put it plainly. It is almost malpractice not to be using technology at this point. Not because it is trendy. Because it is necessary to serve your clients at the level they deserve.

The Bottom Line

If you take one thing from this conversation, make it this. Do not start with the tool. Start with your process. Start with your people. Write an AI policy. Identify pain points from the ground up. Then, and only then, bring in technology that fits your firm, your culture, and your workflows.

The firms that get this right will have a meaningful advantage in the years ahead. The firms that skip the foundational work will spend money on tools that collect dust.

If you want to hear the full conversation with Eric Sanchez, check out the Trial Lawyer View podcast. And if you want to connect with Eric’s team at Maestro Strategic Partners, contact him at eric@mstratpartners.com.

🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://triallawyerview.com/podcast/eric-sanchez/

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how synergy. can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries.  Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution.  Learn more at: https://partnerwithsynergy.com/liens/

How to Build Medicare Compliance in a PI Firm

Medicare compliance sits at the center of modern personal injury practice operations. Trial lawyers and paralegals face real exposure when Medicare interests go unaddressed or get handled incorrectly. The risk is not abstract. Medicare can assert direct recovery rights, including against plaintiff personal injury firms, with double damages on the table under the Medicare Secondary Payer Act. Building a repeatable Medicare compliance framework inside a personal injury firm protects client recoveries and shields the practice from avoidable liability. The guidance below follows the Total Medicare Compliance framework developed and used by Synergy in daily practice

Why Medicare compliance belongs in firm operations

Medicare compliance is not a closing checklist item. Medicare tracking starts early, often before settlement discussions begin. Mandatory Insurer Reporting and expanding data analytics that results means Medicare identifies settlements quickly. When firms rely on informal processes or wait until funds arrive, mistakes can accumulate. Interest accrues, final demands go unpaid, and files lack documentation to defend decisions later.

A structured compliance process gives a person injury firm control. It replaces reactive problem solving with deliberate planning tied to each stage of the case.  Here is a usable framework for firms handling cases on behalf of Medicare beneficiaries. 

Step one. Identify Medicare status early and consistently

Every Medicare compliance program starts with identification. Your intake and case review procedures should screen for current Medicare beneficiaries.  It is also a good idea to screen for those with a reasonable expectation of Medicare eligibility within thirty months. This group includes clients on SSDI, clients nearing age sixty five, and individuals with qualifying conditions such as ALS or ESRD.

Relying on client memory alone is risky. Build intake questions, document requests, and follow up protocols into your workflow. Confirm coverage using Medicare cards, Social Security status, and insurer information. Early identification drives every downstream compliance decision.

Step two. Report and track conditional payments with discipline

Once Medicare involvement is confirmed, reporting and tracking must follow. Contact the Benefits Coordination Recovery Contractor early to open the file and request a Conditional Payment Letter. Treat this letter as a working document, not a final number. Audit line items for unrelated care and submit disputes as treatment continues.

After settlement, report the full settlement details promptly to trigger the Final Demand. Pay the final demand within sixty days to stop interest accrual, even if you plan to pursue a compromise or waiver. Firms that delay payment expose themselves to interest, Treasury referral, and enforcement actions.

Step three. Address Medicare Advantage and Part D liens

Total Medicare compliance extends beyond traditional Medicare Parts A and B. Medicare Advantage plans and Part D prescription plans assert independent recovery rights, often through aggressive recovery vendors.

Your process should include plan identification, verification of recovery rights, and parallel resolution efforts. Treat Part C and Part D liens as distinct obligations, with separate documentation and negotiation strategies.

Step four. Advise clients on future medical implications

Medicare compliance does not stop with past payments. When a client is a Medicare beneficiary or approaching eligibility, future injury related care matters. You should be advising clients on Medicare Secondary Payer implications tied to future treatment. Or hire experts to do so. 

The CAD framework provides clarity. Consult with Medicare compliance experts, advise and educate the client about future medical exposure, and document each step. If a client declines a Medicare Set Aside analysis or elects to set aside nothing, your file should reflect informed decision making with signed acknowledgment.

Step five. Review release language from the other side carefully

Release language plays a critical compliance role. Overbroad language supplied by defendants often imports workers’ compensation concepts into liability cases, assigns specific set aside figures, or shifts improper responsibility to the client.

Your firm should actively revise proposed language. Focus on language that reflects consideration of Medicare’s interests without creating unintended tax, coverage, or reporting consequences. Avoid making settlements contingent on CMS review of anything. CMS review is voluntary and inconsistent across regions, with no appeal process.

Step six. Start early and collaborate strategically

Medicare compliance improves when planning starts early. Confirm Social Security disability status, collect insurance documentation, and identify ICD codes likely to appear under Mandatory Insurer Reporting. Coordinate with defense counsel to align reporting and coding.

Early intervention also opens strategic options. Future medical exposure sometimes supports higher settlement values when framed correctly. Firms that understand this dynamic use Medicare planning as leverage rather than an obstacle.

Step seven. Document everything

Documentation is the backbone of compliance. Courts and regulators focus less on outcomes and more on process. Your file should show identification efforts, reporting timelines, client education, expert consultation, and decision rationale.

This level of documentation protects your firm if CMS questions something later. It also strengthens internal quality control and training.

Why firms turn to Medicare compliance partners

Most personal injury practices recognize the limits of internal resources. Medicare Secondary Payer law evolves constantly. Medicare procedures shift. Recovery vendors change tactics. Building deep internal expertise across conditional payments, Part C liens, future medical analysis, and release drafting strains even experienced teams.

Partnering with a specialized Medicare compliance provider supports ethical practice, protects client recoveries, and reduces risk exposure. Synergy’s Total Medicare Compliance approach integrates identification, resolution, documentation, and education into a single workflow designed for trial lawyers and paralegals who need reliable outcomes, not theoretical guidance.

Building Medicare compliance inside a PI firm is a deliberate operational decision. Firms that commit to structured processes, early action, and expert support position themselves as responsible advocates who protect both clients and practice.

Written by: By Jason D. Lazarus, J.D., LL.M., MSCC  | Founder & Chairman of Synergy | Founder of Special Needs Law Firm | Author of Amazon Best Sellers – Art of Settlement & Litigation to Life | Host of Trial Lawyer View by Synergy Podcast | Peak Practice by Synergy Curator

AI Is Coming for Your Client’s Recovery. Here Is How to Fight Back!

Insurance carriers are spending billions on artificial intelligence. The stated goal is faster claims processing and fraud detection. The practical result is something different. AI is being used to systematically undervalue personal injury claims and pressure injured people into accepting less than they are owed.  If you handle PI cases and you are not paying attention to this, you are already behind.

The Problem Is Not New. The Scale Is.

For decades, insurance companies have used software tools to assign values to bodily injury claims. The most well-known is Colossus, a program that converts medical data into severity points and spits out a settlement range. Over 70 percent of insurers in the United States use Colossus or similar software to assess bodily injury claims. The manufacturer’s own sales literature once promoted that the program would reduce bodily injury claims payouts by up to 20 percent.  That was the old playbook. The new one is worse.

Today, carriers are deploying machine learning models that go far beyond Colossus. These systems analyze photos of vehicle damage through mobile apps, cross-reference police reports with medical records, and generate settlement offers before a human adjuster reviews the file. A 2025 McKinsey report found that insurers using AI-driven systems have reduced total claims processing time by 70 percent. Faster processing, though, does not mean fairer outcomes.

AI models are trained on historical settlement data. If an insurer paid lower settlements to certain demographics or geographic areas in the past, those patterns get baked into the algorithm. The system reproduces the old biases while appearing objective on the surface. And because no one outside the carrier knows how these algorithms work, claimants and their lawyers are left in the dark about why a particular number was generated.

How Carriers Use AI Against Your Clients

Here is what is happening on the ground. Insurance AI systems flag claims for denial or reduced payment based on narrow criteria that do not account for individual circumstances. The software assigns weights to specific words in medical records. Terms like “conservative care,” “delayed complaint,” or “pre-existing condition” trigger automatic deductions, even when those terms are medically appropriate and say nothing about the legitimacy of the claim.

The systems fail most in the area that matters most to your clients: noneconomic damages. Pain, suffering, emotional distress, loss of enjoyment of life. These do not translate easily into data points. The algorithm does not know your client. It does not understand how their injuries have changed their ability to work, care for their family, or live their daily life. It reduces a deeply personal experience to a statistical average.

The carriers know that most claimants will not fight an AI-generated lowball offer. They count on it. When the system is designed to produce low offers at scale, and almost nobody pushes back, the math is simple: the insurer profits.

What Trial Lawyers Need to Do Right Now

You do not need to become an AI engineer to fight back. You need to change how you build cases and how you present evidence, because the other side already has.

Get the documentation right from day one: AI systems rely on specific diagnostic codes and treatment descriptions. If your client’s pain, functional limitations, and daily impacts are not clearly documented in their medical records with proper terminology, the algorithm treats it as if the injury does not exist. Work with your client’s treating physicians to make sure the records reflect the full picture, not shorthand that a computer will discount.

Demand transparency in discovery: Attorneys across the country are beginning to request algorithmic transparency during the discovery process. Ask for the specific AI tools used to evaluate the claim. Request the data inputs, the weights assigned, and the output. Ask whether a human adjuster reviewed the file before the offer was generated, or whether the number came straight from software. The more lawyers who ask, the more precedent we build.

Hire forensic experts when warranted: In complex cases, consider consulting experts who specialize in evaluating AI-driven claim assessments. They review how the system arrived at a number and identify where the algorithm failed to account for your client’s specific circumstances. This is similar to hiring an accident reconstructionist or an economist. It is one more expert in your toolkit.

Prepare for trial: Colossus and similar systems factor in whether the plaintiff’s attorney has a track record of going to trial. If the algorithm determines the attorney on the file is unlikely to litigate, it generates a lower range. One of the most effective things you do for your client is to make clear, through your actions and your track record, that you are prepared to put the case in front of a jury. Juries do not care about software-generated valuations. They care about real human suffering.

Building Internal AI Policies for Your Firm

While you fight AI on the carrier side, you should also think about how your own firm uses AI. Technology has clear benefits for case management, document review, and research. But there are real risks if you adopt AI tools without a framework for responsible use.

Start with a simple question: does the AI tool serve the client’s interest, or does it create shortcuts that compromise quality? If you are using AI to draft demand letters, review medical records, or identify case patterns, make sure there is a human in the loop who  reviews every output. AI tools make errors. They produce confident-sounding answers that are factually wrong. In a profession where mistakes lead to malpractice exposure, that is a serious concern.

Create a written internal policy for AI use in your firm. Spell out which tools are approved, who reviews the output, and how client data is protected. Make sure your team understands that AI is an assistant, not a decision-maker. The ethical obligation to provide competent representation still rests with you.

The Bottom Line

AI in personal injury is not going away. The global market for AI in insurance is projected to grow from roughly $15 billion in 2025 to over $246 billion by 2035. Claims processing is one of the largest use cases fueling that growth.

The carriers will keep investing in tools designed to reduce what they pay. Your job is to make sure those tools do not succeed at the expense of your clients.

That means better documentation. Smarter discovery. Expert challenges to algorithmic valuations. A willingness to try cases. And a clear-eyed understanding of how the other side is using technology against the people you represent.

The trial lawyers who adapt to this reality will get better results for their clients. The ones who ignore it will find themselves accepting settlement offers generated by a machine that was programmed to pay as little as possible.

Why Synergy is the Answer to Help You Scale

Synergy exists to help firms confront the operational realities being driven by technology and scaling pressure. By removing administrative burdens related to lien identification, verification and resolution, from your staff, we help you strengthen your practice’s capacity for high-value legal work and sustainable growth.

🔗 Want more insights like this?

If you’re a personal injury lawyer ready to scale, streamline, and step into your role as CEO, let’s talk. Join the Peak Practice Community, and learn how Synergy can help you eliminate settlement bottlenecks, resolve complex liens, and maximize recoveries.  Learn more here: https://partnerwithsynergy.com/peak-practice/

If you want to grow and scale your law firm more effectively, consider partnering with Synergy for lien resolution.  Learn more at: https://partnerwithsynergy.com/liens/

David Craig – The Jury Is the Equalizer: What Trucking Litigation Teaches About Building a Stronger Trial Practice

Trial lawyers know that some cases are simply different.  Truck crash cases are a great example.

When a catastrophic trucking case lands on your desk, you are no longer just dealing with negligence. You are stepping into a fight with well-funded corporations, experienced defense teams, and insurers who have spent decades refining their playbook.

In a recent episode of the Trial Lawyer View by Synergy podcast, Jason D. Lazarus, J.D., LL.M., MSCC sat down with nationally recognized trucking attorney David W. Craig of Craig, Kelley, and Faultless LLC to talk about what it really takes to hold dangerous trucking companies accountable and what trial lawyers can learn from these cases when it comes to building stronger, more resilient practices.

The conversation goes far beyond trucking cases. It touches on strategy, technology, firm management, and the mindset required to compete at the highest level.

Here are a few lessons every growth-minded trial lawyer should be thinking about.

When the Playing Field Is Not Level

Truck accident litigation often pits injured individuals against companies with enormous resources.  As Craig explains, trucking companies and their insurers can deploy top tier defense lawyers, experts, and investigators almost immediately after a crash. Without the right legal team on the other side, injured victims may never have a fair shot.

That is why jury trials matter so much in these cases.  “The jury trial is the great equalizer,” Craig explains. It allows ordinary people to hold powerful corporations accountable and ensures that the story of what really happened is heard.

For trial lawyers, the takeaway is clear. Serious cases demand serious preparation. Expertise, resources, and strategic discipline are not optional. It is the price of admission.

The Strategic Mistakes That Cost Cases

One of the most valuable parts of the conversation was Craig’s perspective on the mistakes he sees when lawyers who do not regularly handle trucking cases step into the arena.

Two issues come up again and again.

1. Failing to identify every responsible party

A trucking collision is rarely just about the driver.  There may be brokers, shippers, maintenance companies, contractors, or others involved in the chain of responsibility. Lawyers who treat these cases like standard car accidents may leave significant accountability and compensation on the table.  Craig stresses that experienced trucking lawyers approach these cases differently. They investigate the entire ecosystem behind the truck.

2. Waiting too long to preserve evidence

Evidence disappears quickly after a crash.  Electronic logs are overwritten. Vehicles are repaired. Data downloads are lost.  Craig’s firm deploys a rapid response team immediately after being hired to secure critical evidence. Even if the case ultimately does not proceed, preserving the opportunity for justice is worth the investment.  The lesson for trial lawyers is simple but powerful. Early action shapes outcomes.

Technology Is Changing the Battlefield

Technology is also reshaping how trial lawyers compete with large corporate defendants. Artificial intelligence and advanced tools are helping law firms become more efficient, whether through document review, medical record summaries, or discovery management.

But Craig also raised an important caution. AI is changing how potential clients search for lawyers. In some cases, it may direct injured people toward attorneys who have never tried a trucking case.

That raises an important issue for the profession. Expertise matters, but the signals people rely on to identify that expertise are evolving.  For trial lawyers building their practices, visibility and authority in your niche are becoming just as important as courtroom skill.

Running a Law Firm Like a Business

Beyond the courtroom, Craig shared a candid lesson from his own experience building a successful firm.  Early in his career he believed that hiring talented people and working hard would naturally lead to success.  It did not.  At one point, despite having strong cases and a great team, the firm experienced its least profitable year. The issue was not effort. It was focus.

The solution was introducing operational discipline through metrics, leadership structure, and clear accountability. By implementing key performance indicators and better workflow management, the firm ensured that cases were moving forward at the right pace and that teams were focused on the work that actually drives results.

In other words, the practice of law still requires business leadership. For firms looking to grow, this is a familiar theme within the Peak Practice community. Strong legal work and strong operations go hand in hand.

Making an Impact Beyond the Case

Another powerful part of the conversation had nothing to do with litigation strategy. Craig shared how his firm gives back through safety initiatives like distributing bicycle helmets to children and running distracted driving simulations for local communities. The motivation is simple. Every case represents someone’s life being turned upside down. For Craig, the goal is not just winning cases. It is helping prevent tragedies in the first place. That mindset resonates deeply with the mission many trial lawyers share: making a real difference in people’s lives.

Preparing Every Case for Trial

Perhaps the most important insight from the episode is also the simplest. Craig’s firm prepares every case as if it will go to trial. Not because every case will. But because preparing that way gives clients the strongest possible position whether the case ultimately settles or proceeds to a courtroom. That level of preparation changes the conversation with the defense. It signals readiness, credibility, and resolve.  And in complex litigation against powerful defendants, those signals matter.

The Bigger Picture for Trial Lawyers

The themes from this conversation align closely with what we talk about inside the Peak Practice community. The legal landscape is evolving quickly. Technology is changing the way firms operate. Client expectations are shifting. Competition is increasing.

The lawyers who thrive will be those who combine exceptional trial advocacy with strong operational systems, strategic thinking, and a commitment to continuous learning. In other words, the lawyers who treat their practice like both a profession and a business.  That is what Peak Practice is all about.

If you want to hear the full conversation with David W. Craig, you can listen to the episode on Trial Lawyer View. It is a thoughtful discussion about accountability, preparation, and what it really takes to compete at the highest level in today’s litigation environment.

And if you are building a firm designed for the long run, it is a conversation well worth your time.

🎧 Listen to the full podcast conversation on Trial Lawyer View here: https://triallawyerview.com/podcast/david-w-craig/

🔗 Want more insights like this?

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