The Ethics in Patient Referrals Act of 1989, 42 U.S.C. § 1395nn, otherwise referred to as “Stark”  prohibits a physician from referring Medicare or Medicaid program patients for “designated health services” (DHS) to an entity with which the physician or an immediate family member has a prohibited financial relationship, unless one of the statutory […]
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The Department of Health and Human Services (HHS), Office of Inspector General (OIG) has historically emphasized the importance of “square dealing” with government supported health care programs and urged health care providers to adopt effective practices and procedures that are designed to promote compliance with applicable statutory and regulatory requirements and detect and prevent fraud.
Robert W. Liles has worked in regulatory compliance as a Federal prosecutor and as defense counsel, for more than 25 years. This has provided a unique perspective on the challenges faced by clients in highly regulated industries such as health care, banking and finance. Mr. Liles focuses his practice on fraud defense, internal audits, investigations,
(Updated January 9, 2021): Each year, our attorneys and paralegals review and assess literally thousands of Medicare claims which have been audited (and denied) by Unified Program Integrity Contractors (UPICs) and other contractors working for the Centers for Medicare and Medicaid Services (CMS). Are you preparing for a UPIC audit? If your Medicare or Medicaid
Today, it is more essential than ever that health care providers take great care when assessing a patient’s clinical needs and determining which care and treatment is medically necessary. Once this decision is made, it is imperative that health care providers submitting claims to governmental and private payors fully understand their obligations under the law
Liles Parker attorneys have decades of experience practicing health care law. Several of our attorneys served as Federal prosecutors and held significant positions at the U.S. Department of Justice. Our health care transactional and regulatory attorneys have the knowledge and counseling skills necessary to efficiently resolve your health care business issues at the lowest possible
While considerable attention has been paid to the Affordable Care Act (ACA) and its requirement that “identified overpayments” be promptly repaid to the government, it is important to keep in mind that this repayment obligation was already in place. In fact, the government has long maintained that providers participating in Federal and State health care
Genetic Testing Fraud Prosecutions are on the Rise Around the Country. Are Your Genetic Testing Practices Compliant?
(August 13, 2019): Over the last year, a number of genetic testing fraud investigations and prosecutions have been initiated by Medicare, Medicaid and TRICARE investigators and auditors. While the nature of the diagnostic services at issue are cutting edge, the wrongful conduct associated with these cases often involves old school fraud schemes that are easily
(July 18, 2014): Over the last decade, Compliance Programs have become an essential part of the way large and mid-sized health care providers conduct business. In recent years, small health care providers have followed suit, and Compliance Program development, review and implementation has become a priority if the provider intends on staying within the four
(November 3, 2011): Liles Parker is proud to announce that Michael Cook, Esq. and Lester “Les” Johnson, Esq., have been named co-leaders for the firm’s health law practice group. The firm has grown significantly since its inception in late 2006, having successfully represented over one hundred clients in various health law, Medicare appeal, compliance and