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.

Predictive Modeling: ZPICs Using Data Mining to Identify Medicare Fraud

Medicare, Medicaid & Private Payor Updates /

(April 15, 2011): Over the last decade, the Centers for Medicare and Medicaid Services (CMS) and its contractors (Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Recovery Audit Contractors (RACs)), have steadily assembled an extensive database of the coding and billing practices of Medicare providers around the country. Analyzing this data, contractors have […]

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NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5.

Medicare, Medicaid & Private Payor Updates /

(April 10, 2011): Last week, it was announced that NCI, Inc., one of the nation’s most successful information technology companies had acquired the outstanding capital stock of AdvanceMed Corporation (AdvanceMed), an affiliate of CSC. While the acquisition went largely unnoticed by the health care provider community, the transaction may, in fact, be quite significant. With

NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5. Read More »

ZPIC Audits are Here. When it Rains, it Pours . . . DME Compliance is Essential!

Medicare, Medicaid & Private Payor Updates /

(April 6, 2011): On September 15, 2010, the Inspector General of the Department of Health and Human Services (HHS-OIG), Daniel Levinson, testified before the House Committee on Energy and Commerce, Subcommittee on Health regarding waste, fraud, and abuse in the Medicare program, with a specific focus on durable medical equipment and supplies. Mr. Levinson noted

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HHS-OIG Report Signals an Increase in SNF Audits by ZPICs

Medicare, Medicaid & Private Payor Updates /

(April 1, 2011): Skilled Nursing Facilities (SNFs) are again in the spotlight. A recent report likely signals an increase in future SNF Audits. The Prospective Payment System (PPS) under which SNFs are reimbursed by Medicare has long been criticized by many concerned with “benefit integrity” and curbing waste, fraud, and abuse in the Medicare program.

HHS-OIG Report Signals an Increase in SNF Audits by ZPICs Read More »

The Medicare Administrative Appeal Process

Medicare, Medicaid & Private Payor Updates /

(March 25, 2011): Zone Program Integrity Contractors (ZPICs) have established themselves as the preeminent audit tool of the Centers for Medicare and Medicaid Services (CMS), surpassing both Recovery Audit Contractors (RACs) and Medicare Administrative Contractor (MAC) Benefit Integrity units. Unfortunately, many health care providers and suppliers wait until notice of an audit has been received

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CERT Postpayment Audits: An Overview of the Audit Process

Medicare, Medicaid & Private Payor Updates /

(March 12, 2011): Health care providers around the country are finding their practices and clinics subjected to Medicare post-payment audits by Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Comprehensive Error Rate Testing (CERT) Contractors. While all post-payment audits should be taken seriously, there are real differences between both the contractors and the

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Texas Providers Should Expect Increase in Postpayment Audits of E/M Claims.

Medicare, Medicaid & Private Payor Updates /

(March 8, 2011): In February 2011, TrailBlazer Health Enterprises (TrailBlazer) reported the results of “widespread ” probe reviews the contractor conducted of CPT Codes 99211–99215 related to Evaluation and Management (E/M) claims billed for dates of service 01/01/10 through 06/30/10. The frequency of E/M audits directed at Texas Medicare providers are increasing. Is your practice

Texas Providers Should Expect Increase in Postpayment Audits of E/M Claims. Read More »

Are Medicare ALJs Truly Independent Fact Finders?

Medicare, Medicaid & Private Payor Updates /

(February 20, 2011): Over the years, we have represented a wide variety of health care providers in the administrative appeals process. Our duties have regularly included representation before Administrative Law Judges (ALJs) presiding out of the Western, Southern, Midwestern and Mid-Atlantic Field Offices of the Office of Medicare Hearings and Appeals. (OMHA). In the course

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ZPICs Will Deny Claims with “Signature Stamps” and “Date Stamps”

Medicare, Medicaid & Private Payor Updates /

(February 19, 2011): While the use of “signature stamps” has been prohibited for quite some time, a wide variety of health care providers have continued to use “date stamps” or some other method of memorializing when a document was signed by an ordering or treating physician. While the Centers for Medicare and Medicaid Services (CMS)

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ZPIC Participation in ALJ Hearings is Increasing

Medicare, Medicaid & Private Payor Updates /

(February 12, 2011): Over the last year, we have noted an important trend when representing Medicare providers in post-payment overpayment cases at the Administrative Law Judge (ALJ) level of appeal. Medicare contractors are actively attending and participating in many ALJ hearings. In fact, it is now common for a Zone Program Integrity Contractor (ZPIC) to

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