Robert Liles

Robert W. Liles is Managing Partner at the law firm of Liles Parker in Washington, DC. Prior to entering practice, Mr. Liles was an Assistant U.S. Attorney in the Southern District of Texas. Mr. Liles' background is in health care administration. Prior to becoming a lawyer, Mr. Liles worked in various management positions in hospitals in San Antonio and Houston, Texas.

CMS Issues Proposed Rules About Returning Medicare Overpayments

Medicare, Medicaid & Private Payor Updates /

(February 22, 2012):  The proper handling of Medicare overpayments is an essential responsibility of all participating providers.  Late last week, the Centers for Medicare & Medicaid Services (CMS) released an important proposed rule in the Federal Register that could dramatically affect all healthcare providers, Third-party billers and other entities involved in the healthcare industry. The proposed rule, […]

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Data Mining Tools Can Help Identify Possible Problems

Regulatory Issues | Privacy | Other /

(February 8, 2012): While we all know that many Medicare post-payment audits are often generated as a result of sophisticated data mining analyses, the particular elements of concern which may give rise to a specific provider audit are not always so clear. Health care providers interested in compliance can use data mining assessment tools to

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RAC-Initiated Medicare Prepayment Reviews Will Soon Begin.

Medicare, Medicaid & Private Payor Updates /

(February 7, 2012): In recent years, physicians and other health care providers have faced a wide number of administrative actions and sanctions levied by contractors working for the Centers for Medicare and Medicaid Services (CMS). Zone Program Integrity Contractors (ZPICs) have subjected physician practices to Medicare prepayment reviews, postpayment audits, suspension and / or revocation

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Are HIPAA Whistleblower Provisions Around the Corner?

Medicare, Medicaid & Private Payor Updates /

(January 25, 2012): Historically, home health agencies, physicians, clinics and other health care providers have associated the term “whistleblower” with the filing of a FalSe Claims Act case by an insider, former employee or other individual alleging to have direct knowledge of fraudulent billing conduct by a provider. As health care providers will soon find,

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Is a RAC Prepayment Review of Your Medicare Claims on the Horizon?

Medicare, Medicaid & Private Payor Updates /

(December 19, 2011): As you know, RACs play an important role in the identification of Part A and Part B overpayments. Since the inception of the RAC Demonstration Project in 2005, RACs have successfully identified a number of improper claims, denying payment for reasons ranging from mere technical errors to broad concerns about medical necessity.

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A CERT Audit Is Serious – Don’t Take These Medicare Reviews Lightly

Medicare, Medicaid & Private Payor Updates /

(November 23, 2011): The “Comprehensive Error Rate Testing” (CERT) program was implemented as a mechanism for the Centers for Medicare and Medicaid Services (CMS) to assess whether their Medicare Administrative Contractors (MACs) are properly paying claims. In other words, is a particular MAC failing to identify and deny improper claims? Alternatively, is the MAC denying

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Data Mining is Being Used for ZPICs Targeting Purposes

Medicare, Medicaid & Private Payor Updates /

(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid

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CMS’s New Physician Compare Website to Report on Provider Performance

Medicare, Medicaid & Private Payor Updates /

(November 15, 2011): Last year, the Centers for Medicare and Medicaid Services (CMS) launched their Physician Compare website. CMS’s Physician Compare website allows beneficiaries to research their health care providers. The Affordable Care Act (commonly referred to as “Health Care Reform”) mandated that CMS launch such a website and that it implement physician performance metrics

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