Medicare, Medicaid & ERISA: Navigating the Maze of Government & Private Insurance Liens

When a personal injury case reaches settlement, resolving outstanding medical liens is just as important as securing the recovery itself. Yet the process often becomes a maze of overlapping laws, agencies, and plan administrators, all with different timelines and requirements.

Between Medicare, Medicaid, and ERISA/private insurance liens, firms must manage multiple layers of compliance. Each program operates under its own statute, requiring careful attention to detail, documentation, and timing.

At Compass, we help law firms and their clients navigate this complexity with precision and expertise. From Medicare Secondary Payer compliance (MSP compliance) to Medicaid lien resolution and ERISA lien management, our goal is to ensure that every lien, government or private, is managed with accuracy and compliance, so you can close cases with confidence.

Understanding the Big Three: Medicare, Medicaid & ERISA Liens

Medicare Lien Resolution

Medicare operates under the Medicare Secondary Payer Act (42 U.S.C. §1395y(b)(2)(A)), which prevents Medicare from paying when another party is responsible for the cost of care.

When Medicare has made “conditional payments” on behalf of a beneficiary, those funds must be reimbursed from the settlement. That process involves:

• Confirming conditional payments through the Benefits Coordination & Recovery Center (BCRC).

• Reviewing charges for accuracy and disputing unrelated claims.

• Repaying the Final Demand within 60 days of issuance to avoid accruing interest or Treasury referral.

Failure to follow these steps can expose firms and clients to penalties, including double damages under the MSP Act.

That’s where Compass comes in. Our Medicare lien resolution team manages the process from verification to appeal, ensuring that Medicare settlement compliance is met in every case.

Medicaid Lien Resolution

Unlike Medicare, Medicaid is administered by the states, and every state has its own notification, reduction, and recovery procedures. This makes Medicaid lien resolution particularly complex.

In many states, firms must notify the state agency of the claim early—preferably even before settlement—to allow time for processing. Late notice can stall disbursement for weeks or even months.

Compass assists firms in interpreting each state’s policies, ensuring timely notice, accurate allocation, significant reductions and full documentation of finalization. Our expertise in government medical lien resolution helps prevent costly delays and missed opportunities for reduction.

ERISA Lien Resolution

Employer-sponsored health plans often assert reimbursement rights under the Employee Retirement Income Security Act (ERISA). However, not every ERISA lien carries the same legal weight.

The key question is whether the plan is self-funded (governed exclusively by federal law) or insured (subject to state regulation). Self-funded plans typically preempt state anti-subrogation statutes, meaning fewer opportunities for reduction.

Our process includes:

• Reviewing Form 5500 filings to verify plan status.

• Analyzing plan language for reimbursement or subrogation clauses.

• Identifying equitable defenses when plans seek overbroad recovery.

Compass will review all the applicable documents to ensure that the most effective lien resolution strategy is utilized to obtain maximum reduction.

Why Firms Partner with Compass

Law firms don’t hire Compass just because they’re overwhelmed, they also hire us because compliance and client protection are non-negotiable.

Our team functions as an extension of your practice, adding specialized knowledge, time-tested systems, and consistent results that protect both your clients and your reputation.

The Compass Advantage:

• Precision: Every lien validated line by line.

• Efficiency: Streamlined communication with agencies and plans.

• Innovation: Secure tracking tools for real-time updates.

• Partnership: We work collaboratively, not transactionally.

When you work with Compass, you gain a trusted partner equipped to manage everything from Medicare lien resolution to ERISA lien negotiation with integrity and accuracy.

Close Every Case with Confidence

Partner with Compass for Expert Lien Resolution

Whether your case involves Medicare, Medicaid, or an ERISA lien, Compass provides clarity. We simplify lien resolution through a process built on compliance, accuracy, and transparency. Our specialists handle the details, communication, and documentation, so you can focus on your clients.

Partner with Compass to simplify lien resolution and, protect recoveries,

Explore our full range of lien resolution services to see how we help personal injury firms nationwide streamline medical lien negotiation and close cases with confidence.