UPIC Audits, ZPIC Audits, Medicaid Audits, Private Payor Audits, Medicare Suspensions, Revocations Actions, State Licensure Board Actions
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Robert W. Liles, J.D., M.B.A., M.S.


Robert W. Liles -- Health Law AttorneyManaging Member
Office: (202) 298-8750
Facsimile: (202) 337-5804
rliles@lilesparker.com

 

 

Practice Concentration and Experience:

Robert W. Liles has worked in regulatory compliance as a federal prosecutor and as defense counsel, for more than 20 years. This has provided a unique perspective on the challenges faced by clients in highly regulated industries such as health care, banking and finance. Robert focuses his practice on fraud defense, internal audits, investigations, compliance and regulatory matters. He has represented both individuals and entities in administrative and civil proceedings and in connection with internal compliance reviews.  Robert has achieved an “AV” rating by Martindale-Hubbell, the highest rating that may be awarded to an attorney.  He has also been rated “10.0” (out of a possible 10.0) by AVVO, a nationwide attorney rating service.

Robert first began working in management after receiving both a Master’s Degree in Business Administration and, subsequently, a Master’s Degree in Health Care Administration.  After attending law school, he was hired after graduation as an Assistant United States Attorney (AUSA) in the Southern District of Texas (SDTX). While serving as an AUSA, Robert worked out of the Houston office of the U.S. Attorney’s Office and primarily handled False Claims Act matters and cases.  He was later promoted to serve as Chief of the Financial Litigation Unit for the SDTX.

Shortly after the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Robert was asked to serve as the first National Health Care Fraud Coordinator  and was later promoted to the position of Deputy Director, Legal Programs, for the Executive Office for U.S. Attorneys (EOUSA), a component of the United States Department of Justice (DOJ).  While at EOUSA, he advised AUSAs around the country on civil and criminal fraud statutes, schemes, investigative tools, privacy concerns, and compliance issues. He was instrumental in writing and implementing DOJ guidance on the judicious use of the False Claims Act.  Robert’s work was recognized by DOJ and he was given numerous awards by the agency for his efforts, one of which was a “Director’s Award,” the highest award that can be bestowed by the agency.

Since entering private practice, Robert has continued to build on his knowledge and experience in regulatory matters. He has represented a individuals and entities around the country in a wide variety of regulatory, audit and compliance projects.  He has also represented health care providers in connection with government regulatory investigations and audits by UPIC, ZPICs, SMERCs, RACs and reviews by SIUs working for private payor plans.

Robert is a nationally-recognized speaker and educator on legal and regulatory issues.  He has taught and lectured at regional and national conferences, seminars and webinars to federal and state prosecutors, investigators, auditors, industry representatives, providers and suppliers on a variety of regulatory issues. Notably, while a federal prosecutor, Robert was asked by the Office of Inspector General (OIG) to accompany several of their staff members overseas to train Ukrainian prosecutors and investigators on how to handle allegations of health care fraud and abuse.  Robert also regularly taught HHS-OIG agents and investigators at the Federal Law Enforcement Training Center (FLETC), on Jekyll Island. Recent issues covered in training courses he has taught have included the current audit initiatives being pursued by UPICs, ZPICs, SMERCs, RACs, responding to adverse administrative actions (such as Medicare suspension, revocation or exclusion actions), conducting a GAP analysis, and developing an effective Compliance Plan.

Robert currently serves as outside General Counsel for the American Medical Billing Association and is recommended by numerous national associations and organizations to their members. Several years ago, Robert was asked by Practice Management Institute, one of the nation’s oldest health care administration educators, to develop the curriculum non-hospital Certified Medical Compliance Officers. This certification program has been widely lauded by participants and is believed to be the most comprehensive, targeted compliance certification program currently available to small and mid-sized health care provider organizations. The course was recently approved for physician Continuing Medical Education (CEU) credit.

Robert’s health care management education / background and his prior experience as a federal prosecutor provide a real-world perspective when advising individuals and entities on enforcement and regulatory compliance issues.

Financial / Regulatory Matters Handled:

  • Managed our team in an investigation and document production responding to a subpoena directed to a large, international bank, by the Department of Treasury, Office of Foreign Assett Control (OFAC).
  • Managed our production team’s efforts in responding to a subpoena for documents by the Securities and Exchange Commission (SEC) that was directed to our client, a U.S. bank.
  • Represented bank officer and defended his deposition by the Office of the Comptroller of the Currency (OCC).
  • Represented large international bank in False Claims Act case.

Health Care Regulatory Matters Handled:

  • Represented entities in connection with UPIC and ZPIC audits, and investigations by OIG.
  • Worked with a variety of providers and suppliers to develop and implement an effective Compliance Plan.  Conducted training for staff on statutory and regulatory requirements to be followed.
  • Represented entities in connection with audits by UPICs, ZPICs, RACs, MICs, and MFCUs around the country. Diligently reviewed (and when appropriate), challenged the validity of the statistical methodology used to extrapolate alleged damages in audit cases.
  • Directed internal audit of non-profit corporate operations, policies and procedures to better ensure statutory and regulatory compliance.
  • Conducted internal investigation of alleged malfeasance of corporate employees.  Provided recommendations for the implementation of safeguards to better prevent improper employee conduct.
  • Worked with corporate clients to properly incorporate privacy provisions into the client’s overall effective compliance strategy.
  • Provided assessment and advice to corporate clients on proposed business models, addressing both the prohibition against improper self-referrals, Federal/State Anti-Kickback Act concerns, and violations of Federal/State False Claims Act provisions.
  • Represented individuals and entities in ongoing litigation under the False Claims Act, addressing concerns raised by DOJ and State prosecutors.
  • Managed large document productions on behalf of corporate clients in response to Grand Jury, DOJ and federal agency subpoenas. Advised investors and investment companies with respect to health care sector issues and the possible impact of health care fraud enforcement activities.

Education:

  • South Texas College of Law, Houston, Texas (J.D., 1992)
  • Trinity University, San Antonio, Texas (M.S. in Health Care Administration, 1985)
  • Trinity University, San Antonio, Texas (Master’s in Business Administration, 1984)
  • University of the South, Sewanee, Tennessee (B.A. in Economics, 1982)

Professional Affiliations:

  • Member, American Health Lawyers Association (AHLA)
  • Member, Christian Trial Lawyers Association
  • Member, Health Care Compliance Association (HCCA)
  • Member, American Association of Professional Coders (AAPC)

Recent Awards:

  • America’s Most Honored Professionals:  Top 1% 2017.
  • Rated “AV Preeminent” Highest Possible Peer Review Rating in Legal Ability and Ethical Standards (2003 — 2017).
  • Top Rated Lawyers in Washington, DC & Baltimore (as Published in the Wall Street Journal — Based on Martindale-Hubbell Ratings)(December 2015).
  • Top Rated Lawyer in Health Care for Ethical Standards and Legal Ability (Awarded by Martindale-Hubbell)(March 2015).

Federal Admissions:

  • U.S. Supreme Court
  • District of Columbia District Court
  • Maryland District Court
  • Texas Northern District Court
  • Texas Southern District/Bankruptcy Court
  • Texas Western District Court

State Admissions:

  • District of Columbia
  • State of Texas

Presentations and Speaking Engagements (Partial Listing):

  • New Directions in Home Care & Hospice Conference, Dixon Healthcare Solutions, Las Vegas NV, “New Developments in Regulatory and Judiciary Enforcement of Home Health Agencies.” (2017).
  • National Webinar, American Medical Billing Association, “Employer Scrutiny and Screening for Current and New Employees and Providers.” (2017).
  • National Webinar, Texas Association for Home Care and Hospice, “Employer Scrutiny and Screening for Current and New Employees and Providers.” (2017).
  • Annual Conference, West Virginia State Medical Association, Charleston WV, “Employment Law and the Medical Practice. What are the Risks Facing Your Practice.”  (2017).
  • Annual Conference, West Virginia State Medical Association, Charleston WV, “ADRs, Prepayment Reviews, Postpayment Audits, Suspensions and Revocations – The Impact of these Administrative Enforcement Tools on a Physician Practice.” (2017).
  • National Webinar, Texas Association for Home Care and Hospice, “Reading the Tea Leaves – What are the Top Ten Risks Your Home Health Agency will Face in 2016.” (2016).
  • National Webinar, Texas Association for Home Care and Hospice, “Employer Scrutiny and Screening for Current and New Employees and Providers” (2016).
  • National Webinar, Texas Association for Home Care and Hospice, “Pre-Claim Reviews – Is Your Agency Prepared?” (2016).
  • National Conference, Practice Management Institute, Las Vegas NV, “Compliance and Ethics in the Medical Practice.” (2016).
  • National Conference, Practice Management Institute, Las Vegas NV, “Workplace Violence in the Medical Practice.” (2016).
  • National Conference, National Alliance of Medical Auditing Specialists, Orlando FL Attorney-Client Privilege: Issues to be Considered by Health Care Providers.”  (2016).
  • National Conference, National Alliance of Medical Auditing Specialists, Orlando FL, “What is Your Liability? As the Auditor and Compliance Officer What Role do You Play in Your Day-to-Day Operations?”  (2016).
  • National Conference, National Alliance of Medical Auditing Specialists, Orlando FL, “Developing a Voluntary Disclosure and Refund Policy.” (2016).
  • National Conference, National Alliance of Medical Auditing Specialists, Orlando FL, “Repercussions and Penalties of Non-Compliance. The Potential Price Tag of Not Having a Compliance Plan.” (2016).
  • National Conference, American Medical Billing Association, Las Vegas NV, “The Liles Report: An Update on Compliance.” (2016).
  • National Conference, Professional Association of Health Care Office Management (PAHCOM), Clearwater Beach FL “Reading the Tea Leaves – How Does 2017 Look for Health Care Providers?” (2016).
  • National Conference, American Medical Billing Association, Las Vegas NV, “Rules for Billers in Compliance.” (2016).
  • National Webinar, National Alliance of Medical Auditing Specialists, “The FY 2017 OIG Work Plan: What Should You Expect.”  (2016).
  • National Conference, Association of Otolaryngology Administrators, Chicago IL, “What are the Top 10 Regulatory Risks Your Practice will Face in the Next Year?” (2016).
  • National Conference, Association of Otolaryngology Administrators, Chicago IL, “Professional Courtesy, Discounts and Waivers – When are they Permissible? When are they Likely Illegals?” (2016).
  • National Webinar, Texas Association for Home Care and Hospice, “Home Health Pre-Claim Demonstration Review Project & New HHS-OIG Home Health Audits on the Horizon.” (2016).
  • National Conference, Practice Management Institute, Las Vegas NV, “Compliance and Ethics in the Medical Practice.” (2016).
  • National Webinar, Practice Management Institute, “Compliance News Update.” (2016).
  • National Webinar, American Medical Billing Association, Third-Party Billing Agreements – Does Your Contract Protect Your Interests?” (2016).
  • National Conference, Practice Management Institute, New Orleans LA, “Compliance and Ethics in the Medical Practice.” (2016).
  • National Conference, Practice Management Institute, New Orleans LA, “HHS-OIG Fraud Efforts & Physician Compensation.” (2016).
  • 16th Annual Health Care Business Summit, MedAssets, Las Vegas NV “Regulatory Risks:  The Anti-Kickback Statute, Stark and the False Claims Act”  (2016).
  • Long Term Care and the Law, American Health Lawyers Association, Orlando FL “Tactical Approaches to Claim Audits and Recovery Risks in Home Health and Hospice”  (2016).
  • 15th Annual National Medical Billing Conference, American Medical Billing Association, Las Vegas NV “Provider Exclusions, HIPAA Changes and Legal Issues with ICD-10” (2015).
  • Cutting Edge Home Health Leadership Summit, Dixon Healthcare Solutions, Maui HI, “Defending Your Medicare and Other Government Claims” (2015).
  • West Virginia State Medical Association — Winter Conference, Charleston WV, “Physician Compliance Challenges – Regulatory Risks Areas to be Considered by Your Practice” (2015).
  • Private Duty Conference, Dixon Healthcare Solutions, Las Vegas NV, “Understanding HIPAA and other Privacy Issues Affecting Your Private Duty Agency” (2015).
  • National Conference, Practice Management Institute, San Antonio TX, “Compliance and the Physician Practice: A Glimpse of the Future” (2015).
  • National Webinar Series, Exclusion Screening “Don’t Forget, The OIG Is Not the Only Game in Town!” (2015).
  • National Webinar Series, American Medical Billing Association, “Using an Overseas Billing Company and /or Using the Cloud to Store Your Data: What are the Risks and Benefits of these Practices?” (2015).
  • Home Health Conference, Dixon Healthcare Solutions, Las Vegas NV, “Employment Law Issues Impacting Home Health Agencies” (2015).
  • Home Health Conference, Dixon Healthcare Solutions, Las Vegas NV “Preparing and Responding to Various Medicare Claims Audits” (2015).
  • Doctor’s at Renaissance Conference Center, Edinburg TX, “South Texas Takedown — How to Stay within the Four Corners of the Law” (2015).
  • APPNA, Arlington VA, “Top 10 Steps You Can Take to Improve Compliance and Stay Out of Trouble with the Government” (2015).
  • Private Duty Conference, Texas Association of Home Care and Hospice, San Antonio TX, “Risky Business. . . Avoiding Legal Pitfalls to Protect Your Business and Bottom Line” (2014).
  • Regulatory Educational Group Services, McAllen TX, “Top 10 Steps You Can Take to Improve Compliance and Stay Out of Trouble with the Government” (2014).
  • NSCHBC Annual Conference – San Juan PR, “Be Careful Before Moving to Cloud Computing: A Contrarian View of the Inevitable” (2014).
  • NAMAS Annual Conference, Ashville NC, “Enhanced Provider Exclusion Rules and the Impact on Your Screening Obligations” (2014).
  • NAMAS Annual Conference, Ashville NC, “When to Disclose – Legal Obligations and Options” (2014).
  • Fall Conference — Jefferson IPA, Dallas TX, “Risky Business: Avoiding Program Integrity Pitfalls Currently Facing Your Health Care Practice” (2014).
  • National Webinar Series, Practice Management Institute, “Human Resource / Employee Relations Risks” (2014).
  • National Webinar Series, American Medical Billing Association, “Identifying Risks and Modifying Your Compliance Plan to Take These Risks Into Account” (2014).
  • Rio Grande Valley Healthcare Fraud and Compliance Conference, McAllen TX, “Overview of Health Care Compliance and Relevant Statutory Provisions Now Facing South Texas Providers” (2013).
  • Physician Practice Conference & Annual Business Meeting, West Virginia Medical Association, Charleston WV, “Red Hot Compliance Update — 2013” (2013).
  • National Webinar Series, American Medical Billing Association, “Social Media Concerns for Providers and Billers” (2012).
  • National Webinar Series, American Medical Billing Association,“HIPAA, HITECH and Emerging Risk Areas for 2012” (2012).
  • Fifth Annual Medical Coding Conference, Coding Con, Orlando FL, “Building an Effective Anesthesia Compliance Program” (2012).
  • Revenue Cycle Management 2011, Decision Health, Atlanta GA, “Responding to Unannounced Audits” (2011).
  • Annual Conference, Practice Management Institute, San Antonio TX, “Federal Compliance Panel Addresses Compliance Risks” (2011).
  • National Webinar Series, Practice Management Institute, “Reading the Tea Leaves — Issues of Concern Covered in HHS-OIG’s 2012 Workplan” 2011.
  • National Webinar Series, American Medical Billing Association, “Returning Overpayments to the Government” (2011).
  • National Webinar Series, Decision Health, “What to do When the Auditor Knocks” (2011).
  • Medical Coding, Billing and National Conference, CodingCon, Las Vegas NV, “Impact of Healthcare Reform on Healthcare Entities” (2011).
  • Annual Conference, American Medical Billing Association, Las Vegas NV, “Third-Party Billing Company Compliance Concerns” (2011).
  • Practice Management Institute, Dallas TX, “Compliance Officer Certification Course” (2011).
  • Practice Management Institute, Las Vegas NV, “Compliance Officer Certification Course” (2011).
  • Practice Management Institute, San Diego CA, “Compliance Officer Certification Course” (2011).
  • Practice Management Institute, Alexandria VA, “Compliance Officer Certification Course” (2011).
  • National Webinar Series, American Medical Billing Association, “Health Care Reform and Third-Party Billers“(2010).
  • South Texas Home Health Conference, The Forum, McAllen TX, “Responding to ZPIC Audits and Investigations” (2010).
  • Annual Conference, Practice Management Institute, San Antonio TX “Medicaid Integrity Contractors: The Newest Challenge Faced by Providers” (2010).
  • Annual Conference, Practice Management Institute, San Antonio TX, “Responding to an Audit by Medicaid Integrity Contractor” (2010).
  • Webinar, Rocky Mountain Chapter – American Medical Billing Association, “Current Issues Facing Third-Party Billing Companies” (2009).
  • Annual Convention, Practice Management Institute, Las Vegas NV, “Medicare Audits: How to Respond to a RAC Review” (2009).
  • 9th Annual AMBA National Conference, Las Vegas NV, “RAC, PSC and ZPIC Audits — How to Respond if Your Practice is Audited” (2009).
  • 21st Annual PAHCOM Conference, Phoenix AZ, “Current Risks Faced by Physician Practices” (2009).
  • National Conference, Practice Management Institute, San Antonio TX, “Responding to PSC and RAC Audits” (2009).
  • Medical Billing and User Conference, CodingCon, Orlando FL, “Issues Facing Third-Party Billing Companies” (2009).
  • National Conference, Practice Management Institute, Las Vegas NV, “A New Breed CMS Auditor: PSCs and RACs” (2008).
  • Regional Conference, Practice Management Institute, Anaheim CA, “A New Breed of CMS Contractors: PSCs and RACs” (2008).
  • Regional Conference, Decision Health, Atlanta GA, “Keynote Speaker: Post-Election Legislative Initiatives” (2008).
  • Regional Conference, Decision Health, Atlanta GA, “Provider-Vendor Relationships: How to Stay on the Right Side of the Red Line” (2008).
  • Fall Health Care Conference, Practice Management Institute, San Antonio TX, “RACs and PSCs: Addressing Audits by CMS Contractors” (2008).
  • Central Illinois Chapter Meeting, American Medical Billing Association, Chicago IL, “Issues Facing Third-Party Companies” (2008).
  • National Conference, American Medical Billing Association, Las Vegas NV, “Issues Facing Third-Party Billing Companies” (2008).
  • Semmelweis Annual Conference, Washington, DC, “History and Current Status of the False Claims Act” (2007).
  • Annual Convention, Medical Association of Billers, Las Vegas, NV, “Compliance Violations and Penalties” (2007).
  • Chapter Conference for Medical Office Professionals, American Medical Billing Association, Largo, MD, “Health Care Fraud: Audits and Investigations” (2007).
  • Semmelweis Society Annual Conference — Washington, DC, “Bad Faith Peer Review Concerns” (2006).
  • Prosecuting Chiropractic Fraud Cases, NCHAA, Harrisburg, PA, “Chiropractic Fraud Issues” (2006).
  • Health Care Fraud Issues Faced by Medical Group Managers, MGMA, Washington, DC, “Health Care Fraud Update” (2006).
  • Annual Conference, American Medical Billing Association, Las Vegas, NV, “Keynote Speaker: Health Care Compliance” (2006).
  • Medical Practice Coding & Compliance Summit, Practice Management Institute, San Antonio TX “Health Care Fraud: Issues and Concerns from a Legal Perspective” (2006).
  • Intensive Session in Trial Advocacy Skills, National Institute of Trial Advocacy, Washington DC, “Trial Advocacy Skills” (2003).
  • Health Privacy, American Academy of Pediatric Dentistry, “HIPAA Privacy: An Essential Element of an Effective Compliance Strategy” (2003).
  • Webinar, Ohio Hospital Association, “Handling Overpayments — Selected Issues and Considerations“(2003).
  • Intensive Session in Trial Advocacy Skills, National Institute of Trial Advocacy, Washington DC, “Trial Advocacy Skills” (2002).
  • Trinity University and the Greater San Antonio Hospital Council, San Antonio TX, “How to Respond to a Federal Investigation of Your Hospital or Medical Practice” (2002).
  • Greater New York Chapter of the American Corporate Counsel Association, New York NY, “How to Respond to a Federal Investigation of Your Company“ (2002).
  • Member Teleconference, Ohio Hospital Association, “New Leadership: What to Expect from DOJ and HHS-OIG” (2001).
  • Health Care Fraud Enforcement Issues and Considerations, Georgia Podiatric Association, Atlanta GA, “2001 Podiatric Coding & Practice Management Summit” (2001).
  • Member Teleconference, Healthcare Financial Management Association, “Health Care Fraud Enforcement Efforts This Year and Beyond“(2001).
  • Annual Meeting: Legislative Update, Academy of Managed Care Pharmacies, San Antonio TX, “Pharmaceutical Legislative Initiatives” (2001).
  • Ukrainian Prosecutors and Interior Ministry of Interior Law Enforcement Officials, Sponsored by the Department of Health and Human Services, Office of Inspector General, Kharkov Ukraine, “Civil and Criminal Health Care Fraud Enforcement” (multiple sessions covering various aspects of this topic)(2000).
  • Evaluator Team Leader Training, Executive Office for U.S. Attorneys, “Priority Prosecution Areas” (2000).
  • ABA Health Care Fraud Conference, “Priority Prosecution Areas” (2000).
  • Midwest Regional Nursing Home Fraud and Abuse Conference, Chicago IL, “Moderator, Nursing Fraud and Abuse Enforcement Panel” (1999).
  • Basic Health Care Fraud Enforcement, Federal Law Enforcement Training Center, Glynco GA, “Civil & Criminal Health Care Fraud Statutes” (1999).
  • Advanced Health Care Fraud, National Advocacy Center, Executive Office for U.S. Attorneys, Columbia SC,  “Qui Tams” (1999).
  • National Level Health Care Fraud Working Group, Executive Office for U.S. Attorneys, Columbia SC, “False Claims Act and National Project Developments” (1998)
  • National Civil Chiefs Seminar, National Advocacy Center, Executive Office for U.S. Attorneys, Columbia SC, “Use of the False Claims Act in Civil Health Care Matters” (1998).
  • Basic Affirmative Civil Enforcement Seminar, Executive Office for U.S. Attorneys, Columbia SC, “Use of the False Claims Act” (1998).
  • Texas Statewide Financial Litigation Conference, San Antonio SC, “Health Care Fraud Collection Issues” (1997).
  • Basic Health Care Fraud Prosecution Team Training, Executive Office for U.S. Attorneys, Washington DC, “Investigative Techniques & Issues” (1997).
  • Affirmative Civil Enforcement, Executive Office for U.S. Attorneys, Washington DC, “Role of Auditors & Investigators” (1997).