Synergy Blog

How Health Care Reform May Affect Settlements

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act of 2010 into law. The enactment of this law heralds a new era in American health care and insurance practices. Though there are many conflicting views on the changes that the law creates, there will definitely be a shift in how insurance companies and health care providers operate from now on. In reviewing the basics of Health Care Reform, there are many aspects that may have an affect on future settlements in cases where an insurance company or provider has made payment. It will be important in the coming months and years for attorneys to be aware of the status of their client’s insurance eligibility and enrollment, and to continue to remain compliant throughout the case management process. Based on some of the basic tenents of the Patient Protection and Affordable Care Act of 2010, here are a few things that the trial bar may see in the future:

  • Medicare – CMS is already in the process of implementing MMSEA Section 111 Mandatory Reporting guidelines for the specific purpose of identifying and recouping overpayments made by Medicare. According to the Department of Health and Human Services, Medicare premiums will be lowered by “reducing overpayments to private plans” ( The recovery of overpayments is expected to return millions of dollars to the Medicare Program. Expect to see a continued push by CMS Medicare Secondary Payer to expose and recover any overpayments made in liability, no-fault, and Workers Compensation cases.
  • Medicaid – One of the primary purposes of the Health Reform Act is to provide health care benefits for those who are unable to afford coverage. State Medicaid, Medicaid Managed Care/HMO plans, and SCHIP plans may be expanded through additional funding for “community based services” which includes Medicaid programs. With added funding, Medicaid programs will also have an increased responsibility to recoup overpayments in third party liability cases. Expect to see an increase in the number of State provided beneficiaries, and be sure to address any interests by their state plan in order to preserve their benefits.
  • Hospital/Provider Liens – With more options for health care coverage, there will be a reduction in “uncompensated care”, or services provided to the uninsured that are never paid. In Florida for 2009, unpaid provider claims totalled $3.5 Billion dollars, according to Expect to see a decrease in Hospital and Provider liens, as more Americans will have insurance in the near future.
  • ERISA/Private Insurance – See Ask a Lien Professional – ERISA Subrogation & Reform

Synergy will continue to provide insight into the new changes in the Health Insurance and Subrogation landscape. Contact us to receive more information about our Lien Resolution Services and Compliance Training. We are the Complete Solution for Lien Resolution! (877)907-LIEN

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Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

Understanding Structured Settlements and Medicare Set-AsidesThird Thursday Webinar Series

The parties agree that a Medicare Set-Aside is needed, now what? In this month's webinar, presented by Synergy CEO, Jason D. Lazarus, you will learn about the process basics for setting up a set aside including MSA allocations, funding mechanisms for set-asides, post-settlement administration as well as an overview of the process to make sure you close the case compliantly.

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