Client Testimonials

While each client and each case of the firm is unique, we are setting out below a representative sampling of some of the types of matters Liles parker (LP) has successfully handled. Names, Location, and specific details have been omitted or changed to preserve client identity. (Please be aware that any success in a previous case is no guarantee of a successful outcome in a a future success)

• EXTRAPOLATION  - LP received a QIC decision involving E/M extrapolated hospital services. Out of 70 claims, we won all but 3! Since the UPIC is AdvanceMed, we expect the extrapolation to be thrown out in its entirely. This was a “bet the farm” case for the client and L delivered a solid victory just in time for Christmas.
• CHIRO ENROLLMENT - LP successfully defended chiropractic practice in Medicare enrollment dispute with CMS.
• REVOCATION over "Direct Supervision"-  HK had a great win in a highly complex, long-fought Medicare Revocation Case. Here’s the facts: a licensed clinical psychologist, provided counseling and psychotherapy services to nursing home patients. The patients were a mix of Medicare, Medicaid and private insurance. Dr. X also supervised a licensed professional counselor (LPC), whose services were billed as incident to Dr. X’s. Health Integrity performed data mining and considered the number of services billed by Dr. X to be high. A team of Health Integrity investigators interviewed Dr. X. and her LPC, allegedly because they were trying to fine-tune some algorithms that could help Health Integrity identify true fraudulent billing but not sweep in providers who billing a high number of services yet billing appropriately. After the interviews, Health Integrity revoked Dr. X’s Medicare billing privileges on the grounds that she improperly allowed the LPC to utilize her Medicare billing number by not providing “direct supervision”. The matter was eventually appealed to an ALJ, and CMS filed a motion for summary judgment. The key issue seemed to be that Health Integrity (and CMS) was applying an unnecessarily strict definition of “direct supervision”, almost seeming to require that Dr. X be in the same room as the LPC while she was providing the incident to services. The ALJ found in our favor, rescinding the Medicare billing privileges revocation, ruling that the documentation we submitted clearly supported a finding that Dr. X has properly supervised the LPC.
• HOME HEALTH - LP argued multiple adverse home health claim determinations before Administrative Law Judges and received favorable decisions
• CHIRO EXTRAPOLATION - LP successfully challenged extrapolated Medicare overpayment claim for a chiropractic clinic
• PROBE & EDUCATE AUDIT - LP has been with working with a long-time home health agency and just received a call from Palmetto regarding the client’s Probe and Educate audit. With L persistence, the client tracked down all of the information she identified as missing and just found out that 100% of the claims have been deemed favorable!
• HOME HEALTH EXTRAPOLATION - LP had HUGE win in this home health case. The original over payment was $3.3 million. We successfully argued that the extrapolation was defective and got it thrown out at the REDETERMINATION LEVEL! The client’s over payment is now only $26,000. (This is yet another example of the need to get involved in cases at the earliest possible moment so that any and all defenses can be asserted.)
• HOSPICE ZPIC AUDIT - L successfully  handled another post-payment ZPIC audit. In this case, LP were brought in to represent the client after the hospice had unsuccessfully handled the first level of appeal and had lost all 29 claims. The ZPIC originally denied the claims on the basis that there was evidence (based on beneficiary interviews) that they were not rendered. When the MAC issued the redetermination appeal decision, it denied the claims on MULTIPLE bases, citing reasons far beyond those cited by the ZPIC. L challenged the redetermination, pointed out the fact that under SE1521, Limiting the Scope of Review on Redetermination and Reconsideration (effective on redetermination and reconsideration decisions after 08/01/15), the MAC was prohibited from looking beyond the scope of the ZPIC’s denial reasons. After getting the MAC to reopen the decision, she quickly worked with the client to obtain declaration statements from the beneficiaries (with witness signatures) affirming that the services were, in fact, provided. The MAC tried to block the declarations but Lorraine prevailed. As a result, when faced with only the denial reasons cited by the ZPIC, the MAC overturned each of the denials and ruled that 100% of the claims qualified for coverage and payment.
• POST PAYENT AUDIT - LR successfully handled a post-payment audit by SafeGuard Services. In this case, LP was brought in to represent the client when the initial Request for Records was issued by SafeGuard Services. We assisted the client in “putting their best foot forward” so to speak, L succeeded in showing the ZPIC that there was no reason to pursue an overpayment in this case. Once again, this shows the importance of getting involved in a case as early possible BEFORE an overpayment assessment has been issued.

• DENTISTRY AUDIT  - LP represented dental practice before the State Board of Dentistry to demonstrate compliance with state regulations