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.

Improper Medicare Payments Are Still Being Made for Deceased Beneficiaries

Medicare, Medicaid & Private Payor Updates /

(November 20, 2013): While most health care providers and suppliers are diligent in their efforts to ensure that Medicare services are submitted appropriately, mistakes and other improper billings still take place. Two areas of continuing concern involve providers and / or suppliers who submit fraudulent claims to Medicare seeking reimbursement on behalf of deceased beneficiaries […]

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TSBDE Update: Texas State Board of Dental Examiners

Dental Audits & Compliance /

(November 11, 2013): TSBDE Update – The Texas Legislature first provided for licensure of dentists in 1897, whereby district judges were empowered to appoint a Board for their districts consisting of three practicing dentists living in the district. In 1905, Senate Bill 84 created the Texas State Board of Dental Examiners (TSBDE or Board). The

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Health Integrity Educational Letter Sent to Home Health Agencies in Texas and Oklahoma

Home Health & Hospice /

(November 8, 2013): Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Zone 4. This zone is comprised of Texas, Oklahoma, New Mexico and Colorado. Generally, Health Integrity has been assigned responsibility for handling Medicare Part A, Medicare Part B, and Durable Medical Equipment (DME) claims. Health Integrity has been especially aggressive in

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Wake Up Sleep Labs! OIG is Concered About Questionable Billing Practices

Medicare, Medicaid & Private Payor Updates /

(October 24, 2013): Over the next year, sleep lab / sleep medicine practices and clinics should expect to receive increased scrutiny from both the Department of Health and Human Services, Office of Inspector General (OIG) and from program integrity contractors working for the Centers for Medicare and Medicaid Services (CMS). These contractors may include Zone

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Should You be Concerned About a Consultant Qui Tam?

Medicare, Medicaid & Private Payor Updates /

(October 16, 2013): Healthcare providers should be on guard – a new type of whistleblower may be an individual you would least expect. Recently, the Department of Justice (DOJ) entered into a multi-million dollar settlement agreement with a Florida-based healthcare provider based on claims that the provider submitted false claims to various Federal and State

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The HIPAA / HITECH Omnibus Final Rule is Here! Is Your Health Care Organization Complying with the Rules?

Regulatory Issues | Privacy | Other /

(September 23, 2013): Effective today, all covered entities and business associates must comply with the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Final Rule. Please keep in mind, the Final Omnibus Rule is 138 pages long. If you have not already read these new requirements, we strongly recommend that all covered entities, business associates

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Prepayment Reviews and Postpayment Audits are Increasing in Frequency — New Guidance has Been Issued to ZPICs

Medicare, Medicaid & Private Payor Updates /

(September 3, 2013): On August 21, 2013, the Centers for Medicare & Medicaid Services (CMS) released “Transmittal 485/Change Request 8079”. This transmittal imposes an obligation on Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) to notify a health care provider prior to placing them on the provider on prepayment or postpayment review. There

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Liles Parker Attorney Presented at the West Virginia Physician Summit

Firm News /

(August 26, 2013): Medicare compliance challenges have increased (rather than decreased) with the passage of the Affordable Care Act and the implementation of Electronic Medicare Records (EMR) systems by physicians and other health care providers around the country. Late last week, Robert W. Liles, Managing Partner at Liles Parker, had the privilege of serving as a

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Improper Medicaid Dental Billing Practices Can Result in False Claims Act Liability

Dental Audits & Compliance /

(August 15, 2013): The primary civil enforcement tool utilized by the federal government is the civil False Claims Act. As discussed below, the False Claims Act is an extraordinarily useful statute for government prosecutors, both in terms of ease of use and in terms of the damages which may be recovered by the government. Sometimes

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Strategic Health Solutions has Initiated an E/M Claims Audit of 99214 and 99215

Medicare, Medicaid & Private Payor Updates /

(August 15, 2013): Over the last few months, Strategic Health Solutions, LLC, a Supplemental Medical Review Contractor, appears to have significantly stepped up its post-payment audits of physicians and non-physician practitioners billing high level Evaluation and Management (E/M) codes. Strategic Health Solutions’ current audit push appears to be focused on E/M services provided to established

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