LIENS
Welcome to Synergy’s blog page dedicated to the topic of lien resolution. Our team of subrogation experts share their InSights and knowledge on the latest developments and best practices in lien resolution. Stay up-to-date with the latest trends and strategies to ensure that you have the information you need to navigate the complexities of lien resolution.
In the world of personal injury litigation, where settlements can make or break a client’s future well-being, coordination of benefits is no longer a side issue, it’s central to protecting your client’s recovery. For veterans, military retirees, and their families, that complexity multiplies when Medicare, TRICARE, or VA benefits overlap. Once you add a client’s injury recovery to the mix, personal injury firms must be careful to avoid compliance pitfalls, reimbursement demands, and potential denial of care.
So how do these benefit systems interact and why does it matter for your client?
The Basics:
TRICARE, TRICARE for Life, and benefits under the Department of Veterans Affairs (VA) provide essential health care coverage to military service members, veterans, and their families, but they serve different populations and have distinct features. TRICARE primarily offers health care to active-duty service members and their dependents under the age of 65. It provides a range of services including medical, dental, and mental health care through various plans like TRICARE Prime and TRICARE Select. In contrast, TRICARE for Life is a premium-free health care program specifically for Medicare-eligible military retirees and their dependents, which acts as a secondary payer to Medicare and enhances benefits by covering additional services not fully addressed by Medicare. On the other hand, benefits under the VA focus on providing comprehensive health care to veterans with a variety of services, including specialized care for service-connected injuries and conditions. While TRICARE emphasizes readiness and access for currently active military personnel, TRICARE for Life reinforces support for older veterans with Medicare coverage, and VA benefits cater primarily to those who have discharged from military service. Each program is tailored to meet the unique needs of its respective beneficiaries, highlighting the complexities of health care available to those who have served in the U.S. Armed Forces.
Who Pays First?
Understanding the payer hierarchy is critical. Medicare, Tricare, and the VA all have distinct rules about who pays when:
- TRICARE acts as a secondary payer to Medicare. If your client has both, Medicare pays first, and TRICARE picks up what’s left, as long as the service is covered under TRICARE.
- VA benefits, however, are not health insurance. The VA provides care for service-connected conditions, often outside the coordination rules that apply to Medicare or TRICARE.
- Medicare is always the primary payer when used with TRICARE, unless the medical condition is service-connected, in which case the VA may take priority.
When a PI settlement enters the equation, things get trickier. Now Medicare’s rights under the Medicare Secondary Payer Act (MSP) come into play, potentially triggering obligations, even if other programs are involved.
Why This Matters in the Personal Injury Context
When a veteran or military retiree is injured and receives a settlement, failing to coordinate correctly between these programs can lead to:
- Duplicate payment recovery demands from Medicare, VA, or TRICARE
- Denial of future Medicare-covered care
- Compromised client recoveries
- Malpractice exposure to the trial attorney
Even more critical, Medicare may conditionally pay for treatment related to the injury, expecting reimbursement once the settlement is finalized. But if TRICARE also pays or the VA is involved, lawyers must untangle the web of who owes what and when.
Practical Example
Let’s say your client is a 68-year-old military retiree with TRICARE and Medicare. They were injured in a motor vehicle accident and treated at a civilian hospital. Medicare pays first; TRICARE covers the balance. The VA is uninvolved unless the injury is tied to military service.
When a settlement is reached, Medicare will seek reimbursement for conditional payments made for injury-related care. But here’s the catch: if TRICARE also paid, there may be a duplicate demand, or worse, a confusing mismatch in what each program believes is owed.
Without a coordinated lien resolution process, your client could be stuck repaying more than required or face future coverage denials.
What About VA?
If care was rendered at a VA facility for a service-connected condition, VA is usually primary, and Medicare/TRICARE may not be involved. But if the injury is not service-connected, Medicare steps in, and the VA may bill the client directly.
The VA also asserts its own lien rights under 38 U.S.C. § 1729, meaning it may demand reimbursement from the PI settlement. These claims are governed by different rules than Medicare and must be negotiated separately—something many lien resolution vendors miss.
Why This is Important to Trial Lawyers
Ignoring or making mistakes regarding these coordination rules can:
- Jeopardize the client’s future care
- Delay disbursement of settlement funds
- Invite government recovery actions
- Create financial exposure for your firm
Worse, failure to account for the VA, TRICARE, or Medicare’s role in paying for care can result in missed reimbursement demands or post-settlement denial of care, problems that could have been avoided with proper coordination.
How We Help
At Synergy, we’ve seen too many cases where failure to understand TRICARE, VA & Medicare benefit coordination has been costly and exposed firms to unnecessary risk. Our team handles the nuanced resolution of VA liens, TRICARE liens, and conditional Medicare payments to protect everyone involved. We believe trial lawyers and their teams should be focused on getting justice, not deciphering overlapping federal benefits. That’s where our expertise comes in.
Final Thought
If your client has any combination of Medicare, TRICARE, or VA benefits, don’t assume that standard Medicare coordination applies. Each program has its own rules, and they don’t always play nicely together. Engage an expert early. Know who paid what. And protect your client’s recovery by engaging experts before funds are disbursed.
Contact Synergy today. Our team of MSP compliance experts can resolve even the most complicated scenarios, so you don’t have to worry.
Written by: Rasa Fumagalli JD, MSCC, CMSP-F | Director of MSP Compliance at Synergy.
In past blog posts, we have explored critical lien resolution topics like: from the cost of post-resolution chaos to the ethics of outsourcing, from deciding which liens to outsource to mastering identification, verification, audit, and negotiation. The picture is clear: lien resolution is a minefield.
But here’s the bigger takeaway: trying to manage it all in-house can drain resources, expose firms to liability, and reduce client recoveries. The right solution for many personal injury firms is partnering with a company like Synergy, where technology and expertise combine to deliver the best outcomes. This “integration” with experts infused with technology is the future of law practice.
Why Integration Matters
Personal injury firms and their teams are at their best when they’re focused on proving liability, causation, and damages. Yet lien resolution requires an entirely different skill set like navigating regulations, negotiating with recovery contractors, and auditing billing records. Trying to manage both under one roof inevitably creates inefficiencies and risk.
By integrating with a lien resolution partner like Synergy, firms can:
- Seamlessly embed expertise into their practice without building it internally.
- Leverage technology like Connexion to track, verify, and resolve liens in real time alongside or integrated with their own case management systems.
- Collaborate as an extension of their team, with Synergy experts handling the most complex negotiations while the firm retains oversight.
Integration means lien resolution no longer feels like an afterthought. Instead, it becomes part of the firm’s core workflow, managed by specialists dedicated to maximizing client outcomes.
The Benefits of Integration
When firms integrate with Synergy, they gain:
- Efficiency – Internal staff are freed from lien-related burdens, allowing them to focus on case progression.
- Expertise on Demand – Medicare, Medicaid, ERISA, FEHBA, and private health liens are all handled by professionals who resolve them daily.
- Stronger Compliance – Integration ensures lien resolution is managed in line with ABA Model Rules and state-specific ethical requirements.
- Improved Client Outcomes – Every reduction achieved through skilled negotiation goes directly to the client’s net recovery.
How It Works
Integration doesn’t mean ceding control. It means collaboration. The process looks like this:
- Case Intake Alignment – From the start, lien identification begins in tandem with case development.
- Shared Systems – Firms access lien tracking and updates through Synergy’s technology platform, Connexion, creating transparency for attorneys and clients alike.
- Expert Negotiation – Synergy steps in where liens are most complex, ensuring no opportunity for reduction is missed.
- Ongoing Communication – Attorneys maintain oversight while Synergy provides detailed reporting and compliance documentation.
The result? A streamlined, integrated workflow where the firm and Synergy operate as one team to protect client recoveries.
Final Thought
Integration is the key to transforming lien resolution from a liability into a competitive advantage. Personal injury firms that partner with Synergy gain more than outsourced support, they gain an embedded ally with the expertise, technology, and processes to safeguard recoveries, reduce risk, and enhance reputation.
With Synergy as an integrated partner, trial lawyers can focus on what they do best, securing justice for their clients, while knowing that every lien is being handled by skilled experts whose mission is to protect the net.
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
Healthcare liens can dramatically reduce a client’s net recovery if mistakes are made, making effective negotiation one of the most important skills a trial lawyer can develop or wisely outsource. So, what makes lien negotiation so critical, and how can firms approach it strategically?
The Stakes of Lien Resolution
Every dollar paid to a lienholder is one less dollar in your client’s pocket. Without careful resolution of liens, it can:
- Drain client recoveries through overpayment or unchallenged charges.
- Expose personal injury firms to liability for failing to properly address Medicare, Medicaid, or ERISA obligations.
- Delay settlements when disputes with lienholders drag on.
In short, effective lien negotiation protects both clients and the law firm.
Laying the Groundwork: Pre-Negotiation Preparation
The best negotiations begin long before contacting lienholders. Key steps include:
- Case Analysis: Review the total settlement and calculate how liens impact the client’s net recovery.
- Lien Assessment: Determine the legal enforceability of each lien and its potential negotiability.
- Client Communication: Explain lien implications to clients, outline potential strategies, and secure approval to pursue reductions.
Preparation ensures that you enter negotiations with clarity and leverage.
Engaging Lienholders Strategically
Direct communication is the first step. Whether by phone, letter, or meeting, the attorney (or lien resolution expert) must present a clear case for reduction supported by medical records, financial data, or legal authority.
Negotiation Tactics That Work
Not all lien negotiations are the same. Different strategies apply depending on the type of lien:
- Financial Hardship: For government liens like Medicare or Medicaid, hardship arguments can open the door to statutory reductions.
- Equitable Distribution: Advocate for proportional reductions, especially where the client has not been made whole.
- Validity Challenges: Dispute unsupported or unrelated charges, holding lienholders accountable for proving their claims.
These strategies require both legal knowledge and persistence, traits that lien resolution experts often sharpen through daily practice.
Closing the Loop: Documentation and Compliance
Successful negotiation doesn’t end with a handshake. It requires meticulous follow-through:
- Document every agreement in writing.
- Confirm satisfaction of liens with waivers or releases.
- Ensure compliance with federal and state requirements to protect the client and the firm.
- Archive records for future audits and transparency.
Why This Matters for PI Firms
Strong lien negotiation isn’t optional, it’s a professional obligation. Done well, it:
- Maximizes client recovery, ensuring settlements fulfill their intended purpose.
- Protects firms from liability, especially in government lien contexts where penalties can be severe.
- Builds client trust and firm reputation, turning satisfied clients into 5-star Google reviews and referral sources.
Final Thought
Negotiating and resolving liens is where the net recovery is won or lost. For personal injury firms, mastering this process, or outsourcing it to specialists, ensures clients receive the maximum recovery they deserve while protecting the firm from unnecessary risk.
At Synergy, we bring expertise, persistence, and proven strategies to the table, helping trial lawyers resolve even the most complex healthcare liens.
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
Navigating hospital and provider liens in personal injury cases can be a labyrinthine process. These liens trigger ethical considerations, generally involve inflated charges, and have intricate state-specific regulations to navigate. For personal injury attorneys, understanding these liens and devising effective strategies to manage them is crucial.
The Challenge with Hospital Liens
Hospital bills often include charges that greatly exceed actual costs. Many hospitals leverage lien rights, often supported by statutes, to attempt to secure payment for these excessive charges. Negotiating from full billed charges is a strategic mistake; these figures are often inflated and not reflective of the true cost of care. Instead, the focus should be on negotiating from a reasonable value standpoint.
Is the claim a lien or debt?
The first step in resolving hospital/provider claims is understanding whether you’re dealing with a lien or a debt. A lien is a legal claim on settlement proceeds, generally established by statute or contractual agreement. Conversely, a debt arises from unpaid medical care. When you are dealing with a debt, the question for the personal injury victim as a starting point is whether they want to resolve the debt from their settlement proceeds. In most instances it does make sense to encourage resolution so as to avoid having debt collection pursued in the future.
In contrast, liens are a legal claim against the personal injury recovery, borne out of statutes and ordinances. For example, while California has consumer-friendly lien laws, Florida’s regulations vary by county. Familiarizing yourself with state-specific lien statutes and common law is essential for effective resolution for a valid lien.
Best Practices for Resolution
- Identify and verify the existence of any hospital lien claims versus just a debt.
- Once identified, check to see if the hospital has properly “perfected” the lien under appropriate state law. Also, determine under your state law the legal limitations on a hospital’s right to reimbursement.
- Confirm whether the hospital has already received any payments from insurance and whether there is a balance.
- Dispute any attempts to balance bill if payments were received from insurance.
- Engage in negotiations using the following as a guide to different available arguments (Note: Not all will apply, assess your case and use appropriate arguments):
- Challenge any unrelated charges in the hospital billing.
- Use reasonableness arguments for the charges.
- Make any arguments available under state statutes for limitations on reimbursement.
- Argue equitable doctrines like common fund or made whole, if available under state law. Raise arguments related to client hardship, limited insurance policy limits, and comparative fault to negotiate further reductions in the lien.
- Use pro rata share types of arguments in cases with multiple lienholders, argue for a pro rata distribution of a set amount of the settlement pool of funds.
- Finalize resolution by obtaining a complete release of the lien from the hospital.
Conclusion
Resolving hospital/provider claims is indeed a complex task, but with a strategic approach, attorneys can effectively manage these claims. By focusing on reasonable charges, understanding local lien laws, and employing robust negotiation strategies, you can mitigate the impact of hospital/provider claims and ensure that your client’s net recovery is protected.
Working with specialized lien resolution companies can provide essential expertise and prevent costly mistakes when it comes to hospital & provider claims. If you want to find out more, contact us today to Partner with Synergy for lien resolution.
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
Lien resolution doesn’t start with negotiation—it starts with identification, verification, and audit. Without these foundational processes, a law firm risks missed claims, overpayment, compliance issues, and dissatisfied clients.
Identification is Mission Critical
You can’t resolve what you don’t know exists. That’s why lien identification is the first and most essential step. From the moment of client intake, firms must gather comprehensive information on potential lienholders, including:
- Government Programs: Medicare and Medicaid liens, which carry strict reporting and repayment rules.
- Private Health Insurance: Potential subrogation or reimbursement claims hidden in policy provisions.
- Hospital and Provider Liens: Often asserted aggressively and sometimes improperly.
- ERISA, FEHBA, and Military Plans: Complex benefit structures that can be difficult to untangle.
A missed lien doesn’t just delay disbursement, it can resurface years later, creating legal and ethical headaches for both the firm and the client.
Verification Is Essential
Not every asserted claim is enforceable. Verification ensures that liens are legitimate, accurate, and legally valid. That means:
- Confirming lienholder claims directly with Medicare, Medicaid, private insurers, or recovery vendors.
- Requesting detailed documentation such as billing statements and Explanation of Benefits (EOBs).
- Matching lienholder claims against medical records to weed out unrelated charges.
- Reviewing insurance policy provisions to confirm actual recovery rights.
Skipping verification leaves your client vulnerable to paying more than what is truly owed.
Auditing Is Key
Once liens are identified and verified, the next step is auditing. This process ensures that every claim aligns with the facts, the law, and the client’s injury. A proper lien audit includes:
- Compiling all lien data into a comprehensive log or spreadsheet.
- Applying audit criteria such as accuracy, relatedness, and compliance with filing requirements.
- Identifying discrepancies, inflated charges, bundled charges or improper claims.
- Disputing errors with lienholders and providing supporting evidence.
A strong audit process protects the client’s recovery and shields the firm from malpractice exposure.
Why It All Matters
Lien identification, verification, and audit are not administrative box-checking, they are strategic safeguards. Without them, firms risk:
- Financial exposure through overpayment or government penalties.
- Ethical violations for failing to safeguard third-party interests.
- Reputational harm when clients receive less than expected from their settlement.
Handled correctly, these processes maximize client recovery, ensure compliance, and strengthen client trust.
Final Thought
For personal injury firms, effective lien resolution starts long before negotiation. Identification, verification, and audit are the cornerstones of protecting both the client’s recovery and the firm’s credibility.
At Synergy, we’ve built structured processes that ensure no lien is missed, every claim is verified, and every dollar is protected. Partnering with us means turning a daunting, risky process into a powerful advantage for your 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
When settling cases involving clients with federal or military healthcare coverage, understanding the complex landscape of lien recovery rights is crucial. This blog highlights key issues and strategies related to federal employee and military healthcare liens.
FEHBA Liens
The Federal Employees Health Benefits Act (FEHBA) covers federal employees, retirees, and their families through specialized health plans administered by private carriers under the Office of Personnel Management (OPM). FEHBA’s preemption of state laws is pivotal; as affirmed by the Supreme Court in Coventry Health Care of Missouri Inc. v. Nevils, FEHBA preempts state laws that might limit these plans’ subrogation rights. This ruling solidified that FEHBA plans can demand full reimbursement from settlements, similar to ERISA plans, although FEHBA plans typically contain more lenient recovery provisions.
To address FEHBA liens, start by reviewing the plan’s language. While FEHBA liens are strong, potential reductions are still possible, given that the plan’s recovery provisions may provide needed negotiating leverage.
Military Liens
Military healthcare programs—such as Veterans Health Administration (VHA), Champ VA, and Tricare—each have distinct reimbursement rights governed primarily by the Federal Medical Care Recovery Act (FMCRA). Unlike other types of liens, these programs do not involve traditional liens but rather direct claims against responsible third parties.
Veterans Health Administration: Recovery rights stem from 38 U.S.C. § 1729 and FMCRA. The VA can pursue reimbursement claims connected to third-party settlements. For the VA, the resolution process involves requesting bills and navigating a tiered review system for compromise or waiver requests.
Tricare: Governed by similar provisions, Tricare’s recovery rights are outlined in 32 C.F.R. §199.12. Tricare does not require set-asides but considers future medical expenses, and recovery claims are managed through the JAG office. Challenges with Tricare include managing attorney fees and determining the military’s right to recover from first-party auto insurance policies.
Key Issues:
- Attorney Fees: Tricare’s form protection agreement often prohibits the government from paying attorney fees, creating complications in settlement negotiations.
- First-Party Auto Insurance: The right to recover from uninsured motorist (UM) coverage is debated and often hinges on specific policy language, as demonstrated in Government Employees Ins. Co. v. Andujar.
Conclusion
FEHBA and military healthcare liens present distinct challenges. FEHBA’s federal preemption necessitates focus on plan-specific language to negotiate reductions, while military liens involve navigating direct claims under FMCRA and managing complex issues like attorney fees and UM insurance recovery.
Working with specialized lien resolution companies can provide essential expertise and prevent costly mistakes when it comes to FEHBA & military liens. If you want to find out more, contact us today to Partner with Synergy for lien resolution.
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
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