Lien Resolution Group is your trusted partner in helping personal injury and mass tort claimants secure the best possible recovery. LRG’s management team has over 50 years combined experience resolving healthcare liens. This experience allows for LRG to efficiently and effectively move claimants expeditiously through the lien resolution process. LRG is a successful combination of subject matter experts and highly skilled operational leaders, creating processes that are standardized to ensure efficiency, recovery policy compliance, and timely distribution.

In personal injury and mass tort settlements, each claimant has individual responsibilities and obligations to notify and potentially pay healthcare providers. In turn, attorneys have professional responsibilities to ensure that such obligations are met and efforts to maintain each claimants’ healthcare benefits are made. As practiced consultants, LRG works for you to determine the best resolution methodology given the applicable law, settlement terms, matter type, size, and geographical distribution of the claimants. From facilitating a global resolution to designing an individualized plan, LRG’s goal is to ensure that reimbursement interests are properly addressed so that funds can be confidently distributed.

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Lien Resolution Process

Medicare Parts A and B

Medicare is federal health insurance benefit program for people 65 years of age and older, for those under age 65 who have certain disabilities, and those who are disabled and have received SSDI benefits for at least 24 months. Medicare is often the initial payer of medical expenses for personal injury and mass tort claimants. What distinguishes Medicare from other health care insurers are the federal regulations allowing Medicare subrogation rights superior to any other interest on a settlement. Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) took effect in 2010 changing resolution obligations, including a settlement reporting requirement on Defendants. LRG should be listed as an authorized agent on any such report so as to avoid disruptions and slowdowns in your case.

LRG will work on behalf of the claimant to verify whether each claimant is a recipient of federal Medicare (Parts A and B) benefits. If no healthcare lien exists, you will be notified that you are cleared. If the claimant is receiving benefits, LRG will audit each reimbursement claim to determine accuracy and remove items unrelated to the injury. The agreed upon resolution methodology will then be applied to satisfy all obligations. If applicable, LRG may apply for a compromise, waiver, or appeal to secure the best possible recovery for the claimant.

State Medicaid

Medicaid is a joint federal-state program that provides health care coverage to certain categories of individuals including children, pregnant women, people with disabilities and elderly adults based on their financial need.  Each category of applicants has different criteria for eligibility.  To qualify for Medicaid on the basis of disability, there is a cap on both the individual’s income and assets but certain types of resources may be exempt from consideration. (See Benefit Planning).

Injured parties encounter problems when Medicaid has made conditional payments for medical services related to an injury and then assert a lien for recovery from the beneficiary’s settlement award. Each state Medicaid agency has its own set of right to recovery laws and regulations.

Once it is determined that a claimant is a Medicaid beneficiary, LRG will work on behalf of the claimant to assess Medicaid’s right to recover and determine to what portion of the settlement proceeds Medicaid can attach. LRG will audit each reimbursement claim to determine accuracy and remove items unrelated to the injury. The agreed upon resolution methodology will then be applied to satisfy all obligations. If applicable, LRG may apply for a compromise, waiver, or appeal to secure the best possible recovery for the claimant.

Private Insurers, including Medicare Advantage (Part C)

In addition to government insurance, many claimants will have private insurance coverage for the injury at issue.  Private insurance can also include Medicare Advantage (Part C), which is replacement health insurance for Medicare Parts A and B that is provided by a private insurer. Private healthcare insurers may have a right to reimbursement if they paid for treatment related to a claimant’s settlement. The plan’s right of recovery depends on many factors, including the contract language and federal and state law.

Upon notice of private coverage or upon request, LRG will work with recovery contractors or the plans directly to gather all relevant material. Depending on the number of claimants involved in the settlement, a Private Lien Resolution Program can be established to resolve potential liens without having to individually reach out to each private health plan. LRG will review and assess the plan’s right to recover based on the plan type and applicable law.  LRG will summarize the lien holder’s interest and recommend a course of action. If a right exists, LRG will audit each reimbursement claim to determine accuracy and remove items unrelated to the injury. The agreed upon resolution methodology will then be applied to satisfy all obligations. If applicable, LRG may apply for a compromise, waiver, or appeal to secure the best possible recovery for the claimant.

Military and Other Healthcare

There are many other types of health plans that may have provided coverage such as: TRICARE, Department of Veterans Affairs (VA), Indian Health Services, (IHS), FEHBA plans (federal plans and/or State plans), and Charity plans. As healthcare insurers, these plans may have a right to reimbursement if they paid for treatment related to a claimant’s settlement.

Upon notice of such coverage or upon request, LRG will work with you to determine the claimant’s obligation to notify these health plans, and if appropriate, we will reach out to such plans and obtain all relevant material. LRG will review and assess the plan’s right to recover based on the plan type and applicable law. LRG will summarize the lien holder’s interest and recommend a course of action. If a right exists, LRG will audit each reimbursement claim to determine accuracy and remove items unrelated to the injury. The agreed upon resolution methodology will then be applied to satisfy all obligations. If applicable, LRG may apply for a compromise, waiver, or appeal to secure the best possible recovery for the claimant.