If you have cases from 2024 which are settled, but you are still holding proceeds pending lien resolution, something is wrong. To prevent that from happening to you in 2025, the attorneys and staff at Cattie & Gonzalez have some practice tips to share to help you handle liens better in 2025.

Typically, when you read something from us, you get the academic, the legal analysis, statutes and regulations. Consider this the opposite. This is not and should not be considered legal advice from Cattie & Gonzalez. Instead, this is practical advice you can use in your cases to achieve better lien resolution outcomes based on years of experience and thousands of liens resolved. 

1 Big Thing: START EARLY!

Why It Matters: It doesn’t matter what type of healthcare lien is in question. Despite what some may say, there is no magic wand when it comes to lien resolution. It takes knowledge and effort, but more than anything, it takes time to get the best results.

The Cold, Hard Truth: Most attorneys wait far too long before starting the lien resolution process. The time to start worrying about liens is not when the case is settled; it’s when you know there is some money at the end of the road. If you know that at the start of the case, so be it. If it takes longer due to tough liability or causation issues, OK. But once you know the case can be resolved for something, don’t delay engaging with potential lienholders. You do your client and yourself a disservice by waiting.

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Lien Specific Tips: Not all healthcare liens are the same. The only common thread is the need to address liens in some way, shape, or form. Even in states that have anti-subrogation statutes, you need to know when those laws apply to a potential lien versus when they don’t. 

Lien-by-lien, here are 3 tips from our team who spent their time in 2024 resolving thousands of liens to help you resolve liens better in 2025:

Medicare:

1)  Seeing Double: Did you know Medicare has not one but two conditional payment recovery contractors? The Benefits Coordination & Recovery Center (BCRC) handles Medicare conditional payments related to automobile, liability insurance (including self-insurance) and denied workers’ compensation claims while the Commercial Repayment Center (CRC) handles Medicare conditional payments for accepted workers’ compensation claims and no-fault insurance claims. Depending on the facts of your case, it’s possible you need information from both the CRC and BCRC.

2)  Ignorance is Bliss: The BCRC and CRC are both particular about who they will communicate with. The BCRC will only communicate with the Medicare beneficiary, the beneficiary’s attorney, or their agent. The CRC will only communicate with the employer/insurance carrier or their agent. If you try to talk to them out of turn, expect to be ignored.

3)  Appeals are Possible (If You’re Not Too Late). When Medicare issues its final demand for payment, your fight does not necessarily end. There exists a five-level post-demand appeals process to continue that fight. Through the stages of Redetermination, Reconsideration, a hearing before an Administration Law Judge (ALJ), and a hearing before the Medicare Appeals Council (MAC), your pleas for logic and reason to prevail for your client may continue to be heard. If your pleas fall on deaf ears and you exhaust all administrative remedies, you now have the requisite standing to bring action against Medicare in federal court. But standing only exists when you exhaust all administrative remedies. And you only get there so long as you have been timely in each step of your appeal. Miss a deadline, and you’re SOL.

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Medicare Advantage/Drug Plans:

1)  Not All Medicare is the Same. Just because you have a Medicare beneficiary for a client does not mean it is one stop shopping with Medicare to handle Medicare conditional payments. Medicare Advantage Plans (MAPs) offering Medicare Part C coverage and Medicare Prescription Drug Plans (PDPs) offering Medicare Part D coverage are each singular points of contact to handle Medicare conditional payments made by that plan. It’s information you cannot obtain directly from Medicare and its Medicare Secondary Payer Recovery Portal (MSPRP), making Medicare conditional payments trickier and more dangerous than other liens.

2)  A Medicare Multiverse of Options. Like the expansion of the Marvel Cinematic Universe (MCU) revealed a multiverse of possible alternatives for Earth’s mightiest heroes, the same is true with Medicare and the plans offered to Medicare beneficiaries to pay for their medical care. The number of MAPs has doubled since 2017 (1,957 in 2017 compared to 3,959 in 2024). These plans offer a variety of options not available under traditional Medicare fee-for-service under Parts A & B and become more popular each year. 

3)  Not All Medicare is the Same, but Their Recovery Rights Are. While the mechanics of how to handle Medicare conditional payments with the federal government differ compared to a particular MAP or PDP, the recovery rights of these entities are the same. Starting with the In Re Avandia decision, MAPs have pursued a strategy of aggressive litigation to strengthen its right of recovery under the Medicare Secondary Payer Act. Same priority right of recovery as the feds, same double damages as the feds, same exposure for attorneys representing the Medicare beneficiary as the feds. Treating MAPs and PDPs like private insurance is a losing lien resolution strategy in 2025.

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Medicaid:

1)  Medicaid ≠ Medicare. These two distinct federal insurance programs are confused all the time by lawyers and lay people alike. Medicare is federally funded and managed while Medicaid is (mostly) federally funded but operated by the states (with limited exceptions for Medicaid Managed Care Organizations – more on that in a minute). The rules for both programs also fall under different federal statutes – Medicare at 42 U.S.C. § 1395, and Medicaid at 42 U.S.C. § 1396. THEY ARE DIFFERENT! You need to treat them as such.

2)  Home Sweet Home. State of residence matters! Make sure to ask your client where they have lived since they got hurt. If they have moved across state lines, then a different state Medicaid agency may be paying their medical bills. This doubles the amount of potential lienholders with whom you need to communicate to resolve all potential Medicaid liens. You cannot resolve the entire Medicaid lien through just 1 Medicaid agency.

3)  Medicaid ≠ Medicaid. In the Medicare world, there is a difference between traditional Medicare from the federal government versus private plans that offer MAPs. The same thing happens in the Medicaid world. On the one hand, state agencies operate Medicaid programs and the recovery of liens associated with those programs. On the other hand, Medicaid Managed Care Organizations (MCOs) are privately-operated, for-profit groups that provide Medicaid benefits to plan members. Medicaid MCOs have the same rights of recovery as traditional Medicaid, so find out early from your clients which type of Medicaid they have.

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Military (VA/Tricare/CHAMPUS):

1)  When Insurance is not Insurance: Not all military liens are the same. In fact, not all military liens involve health insurance. For example, the VA does not involve insurance. Instead, it offers veterans 57 hospitals, 400 clinics and various operations in combat theaters, bases, and ships at which only they can treat. Care is rendered at no cost, apart from exceptions related to the resolution of bodily injury claims. Like the claims you represent them for. Still, the VA has recovery rights under the federal Medical Care Recovery Act (42 U.S.C. § 2651(a)).

2)  Know the Branch of Service: While the US military fights for a common cause, each branch is distinctly different in how they fight for that common cause. Those differences between branches also exist in the lien context. Knowing the branch of service of your client will point you to the proper point of contact to resolve the military lien. You can’t resolve a Tricare lien for an Army Ranger with the Air Force Tricare office; you have to negotiate with the Army Tricare office. While that might make the process less painful, we’re a long way away from that.

3)  No Offsets for Attorneys Fees and Costs: Most lawyers are shocked to learn this. Unlike other liens where lien holders grant procurement costs offsets as a matter of course, that does not happen in the military lien context. You must obtain your reductions in other ways.

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Private:

1)  Know Thy State Law: If a health plan is fully insured, then the preemptive nature of certain statutes, such as ERISA, will not act to circumvent the protections of state law against a subrogating party. As such, it is important to understand your state’s law as it pertains to anti-subrogation, equitable doctrines, statutory lien provisions, and so on. Most of the aforementioned provisions of law have nuance to their application, so make sure to know the law well so that you can apply it to your case successfully.

2)  Motivation Matters: Understand the entity with whom you are corresponding. Is it a subrogation/reimbursement vendor? An individual working in the healthcare provider’s billing department? A collection agency? Outside counsel for a health plan? It is important to understand: (1) with whom you are speaking; and (2) their financial motivations for resolving the case. Subrogation vendors often take percentages from what they recover, outside counsel is likely working on an hourly fee rate, and collection agencies may collect a fluctuating payment based on the speed at which they recover the reimbursable medical bills. Know who you are corresponding with and what will make them say “yes” to an offer, as opposed to “we want it all.”

3)  Pushing the Right Buttons: Depending on who you are dealing with, it is important to understand the theory of recovery that an entity is employing to pursue reimbursement. If the entity is a healthcare provider, does the applicable state have a governing lien statute? Does the statute mandate the pursuit of reimbursement through the mechanism of that the statute provides? In the alternative, is the entity seeking reimbursement pursuing such via a theory of contract? When did the accident occur and what is the statute of limitations? Is the entity bringing an equitable claim or a legal claim? Pushing the right buttons can expedite the lien resolution process.

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ERISA:

1)  Review Before Agreeing: Many times, attorneys will succumb to the frightening prospect of dealing with a self-funded health and welfare benefit plan governed by ERISA. While the case law governing self-funded ERISA plan recovery rights favors the plans, you still have arguments to make and tactics to employ, which can lead to a reduction, if not a full waiver of the lien. You can’t make these arguments if you don’t have all the necessary (read correct) plan documentation. By the way, recovery vendors like Rawlings will know you’re not well-versed in ERISA nuances if you don’t request all the proper documentation from the get-go. Send a proper plan document request to the plan administrator, or if time is of the essence, get it from the vendor!

2)  Hearing ≠ Believing: Every health plan in the nation is self-funded and shielded by the preemptive nature of ERISA --- if you ask the subrogation vendors. Why wouldn’t Rawlings, Phia, Optum, or Equian want to play the subrogation/reimbursement game in the ERISA arena? It’s favorable to them, so you have to show them that any particular health plan is fully insured! Do your research and prove that state law doctrines against reimbursement are applicable to your case! 

3)  Use the Power of the Purse: As many frustrated attorneys and injury victims know, self-funded ERISA plans are notorious for sitting on the sideline and expecting full recovery. The plans do not want to contribute their efforts or their capital, but they do want to be reimbursed before anyone else. It is important to remind them, before settlement, that if you and your client do not recover, neither does the plan. Use the negotiating tactic of “some recovery” versus “no recovery.” Eighty percent of a watermelon is way better than one hundred percent of a grape. Who knows, their bonus might depend on it.

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FEHBA:

1)  State Law No More: For a period of time in the country, controversy existed around the proper law as applied to subrogation and reimbursement provisions in health insurer contracts administered under the FEHBA program. In the modern day, controversy no longer exists. The Supreme Court decided Coventry Health Care of Missouri, Inc. v. Nevils, 581 U.S. 87 (2017), making it clear that FEHBA plans’ subrogation and reimbursement provision “relate to the nature, provision, or extent of coverage or benefits,” and thus, “supersede and preempt any State or local law,” As such, when dealing with FEHBA plans, there is no need to waste time arguing state law doctrines. To do so merely delays the inevitable.

2)  Hit the Plan Language: Given the impact the Nevils decision had on state law arguments as applied to FEHBA plans’ reimbursement efforts, the only fallback at this point is a diligent review of the plan language to forward legal arguments for reduction. Fortunately, FEHBA plans often contain language that is not nearly as draconian as the typical language one might find in a self-funded ERISA plan. This reality should be used to argue for reductions to FEHBA liens to put as much money back in an injury-victim’s pocket as possible.

3)  Do Not Get Discouraged: FEHBA liens are amongst the most difficult to obtain substantial reductions. Federal law always applies, and as such, the opportunity to have a FEHBA lien completely waived is essentially non-existent. However, creating a good relationship with the subrogation representative, making a strong case as to why a reduction is necessary, and leaning on weak plan language when it shows up can result in consistent success over time as more and more FEHBA liens come across your desk. A congenial disposition and willingness to cooperate go a long way.

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The Bottom Line: Lien resolution done right takes reps. Experience makes it better. Knowledge makes it better. TIME makes it better. If you devote your time to become a better lien resolution attorney, your clients will achieve a higher amount of net proceeds, putting more money in their pockets. 

The same idea applies to your personal injury practice. Personal injury law done right takes reps. Experience makes you better. Knowledge makes you better. TIME makes you better. When you devote your time to become a better personal injury attorney, your clients will achieve a higher amount of net proceeds, putting money in their pockets.

But you only have so much TIME to go around. Choosing between the two, you will certainly spend more time honing your personal injury practice as opposed to becoming a better lien resolution attorney. Besides, you get paid for your personal injury practice, not by becoming a better lien resolution attorney.

Thus, the reasons for the lien resolution practice tips for 2025. There are many more to share, and we will as 2025 marches forward. Until then, start to implement these in your practice. Address liens earlier. Understand the basic differences between Medicare & Medicaid, Medicare & Medicare Advantage, VA & TriCare, and so forth. And remember, Cattie & Gonzalez is always here to help if you get a question you can’t or don’t want to answer when it comes to healthcare liens.