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.

2011: The Year of Compliance – Medicare Payment Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 26, 2011): Medicare payment suspension action can prove disastrous for your practice or home health agency. How did we get to this point? The recent debate over healthcare in this country has drawn attention to healthcare costs as well as the relationship between healthcare providers and the Federal government. With healthcare costs steadily on […]

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White House Issues Executive Order to Improve the Regulatory Process

Regulatory Issues | Privacy | Other /

(January 18, 2011): Earlier today, President Obama signed an Executive Order and Memoranda to the heads of executive agencies to redesign the regulatory process. Health care is one of the most highly regulated industries in the county. Thus, the manner in which the United States Department of Health and Human Services (“HHS”), the Department of

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2011 The Year of Compliance. Avoiding ZPIC Audits and ZPIC Suspension Actions

Medicare, Medicaid & Private Payor Updates /

(January 11, 2011): ZPIC audits and ZPIC suspension actions are a serious risk facing non-hospital providers today. As you recall at the end of 2010 we identified the “Top Ten Health Care Compliance Risks for 2011”. The purpose of this article is to analyze two of those risks; Zone Program Integrity Contractor (ZPIC) audits and

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HEAT Investigations of Health Care Fraud in South Texas

Regulatory Issues | Privacy | Other /

(January 6, 2011): Three Houston-area residents, one of whom is a physician, were sentenced to prison on January 4th for their roles in a multi-million dollar durable medical equipment (DME) Medicare fraud scheme. Each of the three defendants were also ordered to pay restitution to the Federal government, in amounts ranging from $29,052 to $1.4

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Top Ten Health Care Compliance Risks for 2011

Medicare, Medicaid & Private Payor Updates /

(December 31, 2010): In case you missed it, Congress, President Obama and the healthcare regulators had a banner year with respect to regulatory activism in 2010. Over the next several weeks we will be releasing a series of articles on our website addressing the compliance risk areas facing your organise dramatic changes and the compliance

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Keeping an Eye on the Medicare AdQIC

Medicare, Medicaid & Private Payor Updates /

(May 16, 2023): The Medicare program is enormous. The Centers for Medicare & Medicaid Services (CMS) estimates that Medicare Administrative Contractors (MAC) process 1.2 billion[1] fee-for-service claims each year in connection with the original[2] (or traditional) Medicare program. If you have ever been involved in a Medicare postpayment audit (or even a prepayment audit[3]) where

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Virginia Judge Concludes That Health Care Reform Law is Unconstitutional

Medicare, Medicaid & Private Payor Updates /

(December 13, 2010):  A Federal Judge for the Eastern District of Virginia concluded that the provision of the recent Health Reform Law may be unconstitutional.  that penalizes/taxes individuals who fail to purchase health insurance, violates the United States Constitution.  In doing so, the Court reaches a different conclusion than two other Federal courts – one

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Provider Exclusion Screening / OIG Screening Practices are a Significant Risk

Medicare, Medicaid & Private Payor Updates /

(December 11, 2010): Has your practice conducted exclusion screening / OIG screening on all of you employees?Earlier this week, HHS-OIG announced that it had assessed significant civil monetary penalties against a health care provider that employed seven individuals who the provider “knew or should have known” had been excluded from participation in Federal health care

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HHS Publishes Proposed Rules on Medicaid RACs

Medicare, Medicaid & Private Payor Updates /

(November 30, 2010): The United States Department of Health and Human Services (“HHS”) recently published a Proposed Rule applying the Recovery Audit Contract (RACs) process to claims under the Medicaid program. As background, the RAC process has been a part of the Medicare program since 2005, first as a demonstration project from 2005 – 2008,

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CMS Authorizes Medicare Appeals by Fax and Secured Internet

Medicare, Medicaid & Private Payor Updates /

(November 21, 2010): Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 6958, titled “Guidelines to Allow Contractors to Develop and Utilize Procedures for Accepting and Processing Appeals Via Facsimile and/or Via a Secure Internet Portal/Application.” Health care providers and their counsel welcomed the guidance, anticipating that this change

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