Medicare & Medicare Advantage
Medicare has a statutory right to reimbursement from all liability insurance, no-fault insurance, and worker’s compensation insurance per 42 U.S. Code Section 1395y(b)(2)(A) and (B). When a case resolves, Medicare is entitled to reimbursements for injury-related payments. Compass will obtain the conditional payment amount, audit the claim for unrelated charges, and finalize a lien upon resolution. For more complex liens, Compass may be required to appeal a decision by Medicare or to apply for a financial hardship waiver.


Although traditional Medicare is through the federal government, many claimants may purchase additional Medicare coverage through a private insurance plan. These are known as Medicare Advantage or Medicare Supplemental plans. Both the traditional Medicare and private Medicare plans must be consulted regarding potential liens. For Medicare Advantage or Medicare Supplemental plans, Compass will obtain the lien, will audit the claim for unrelated charges, and will negotiate the lien upon settlement.
Medicaid
In Medicaid cases, the coverage is provided by the state of residency. Compass will consult each state in which the claimant resided during the time of the injury-related treatment to obtain the lien, dispute any unrelated charges, and finalize the lien. In more complex cases or those where recovery is limited, Compass may perform an Ahlborn analysis to determine if additional reductions can be obtained.
ERISA
ERISA liens are one of the most complex lien types. These plans often have a strong right to recovery. Compass expertly handles these claims by verifying the plan funding (self-funded vs. insured ERISA), determining the recovery rights through analysis of the plan language, and utilizing all available strategies to negotiate these liens to achieve the maximum reductions available.
Private Liens
Where a claimant purchases private insurance or receives a plan sponsored by an employer, a private lien may arise. Compass will obtain these liens, verify the plan’s recovery rights, conduct a reduction analysis based on applicable law, and finalize the lien.
Hospital Liens
Hospital liens are statutory liens asserted by a hospital where the claimant treated for injury related treatment. Compass will obtain these liens, verify the legal sufficiency of the lien, conduct a reduction analysis based on applicable law, and finalize the lien.
Tricare & Veterans Affairs
In cases involving a plaintiff who is an active-duty military member, is a dependent of a military member, or is a retired military member, Tricare or Veterans Affairs often will assert a lien. Compass will obtain the lien from the appropriate military office, evaluate any reduction options or unrelated charges, and finalize the lien.
Medicare Set-Asides
Compass provides deliberate and careful analysis on how to consider and appropriately protect Medicare’s future interests. It is unclear whether a Medicare Set-Aside is required in a liability case. The Medicare Secondary Payer Act warns that Medicare may not pay medical expenses when payment has been made or can reasonably be expected to be made in a liability case. Compass provides clear and concise guidance on MSP compliance and best practices on protecting both the attorney and plaintiff.
