"Nationwide Healthcare Lawyers"
(January 13, 2026): As the great Yogi Berra once said, “It’s tough to make predictions – especially about the future.” This maxim is especially true when it comes to forecasting the specific dental claim risk issues that will be the focus of private payor Special Investigation Units (SIUs) in 2026. Nevertheless, we are going to […]
Delta Dental Audits Will Increase in 2026. Is Your Practice Ready? Read More »
(December 09, 2025): The Government Accountability Office (GAO) has long expressed concerns regarding the fraud, waste and abuse risks inherent in the Medicare program. In fact, GAO first designated Medicare as a “High Risk” program due to its size, complexity and susceptibility to improper payments.[1] Throughout 2025, Medicare providers and suppliers were subjected to significant
Prior Authorization Demonstration Audits for Certain ASC Services Start in January 2026 Read More »
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,
Robert W. Liles, J.D., M.B.A., M.S. – NEW Read More »
(November 20, 2023): Medicare, Medicaid, and most private insurance plans cover hospice care and related services. To be eligible for hospice care,[1] a patient must be certified as terminally ill and have a life expectancy of six months or less. In recent years, the hospice industry has exponentially grown, and the number of Federal, State
Hospice Audit and Investigative Actions are Expected to Rise in 2024 Read More »
(October 10, 2023): In terms of revenues and expenses, health care providers and suppliers have repeatedly faced two unfortunate realities: (1) Reimbursement rates are shrinking, and (2) they are constantly being saddled with additional unfunded mandates (for example, HIPAA compliance, OSHA requirements, compliance obligations, etc. Coupled with ordinary practice expenses, many health care providers are
AI in Medical Billing: A Benefit or a Compliance Risk? Read More »
(June 27, 2023): In the State of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million[1] Texans (approximately 18.9% of the current population[2]) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40
TAHCH Webinar Updates on Vaccine and Mask Mandates Tuesday, January 4, 2023 1 p.m. EST / Noon CST / 10:00 a.m. PST Duration: 60 Minutes Jennifer Papapanagiotou JD, MS, BS Heidi Kocher JD, CHC, MBA, BS COVID vaccine and mask mandates have come, been amended, been removed for some occupations or sites and left in
(October 12, 2022): The False Claims Act is the primary civil enforcement tool utilized by our government today. In Fiscal Year (FY) 2021, the U.S. Department of Justice (DOJ) won or negotiated over $5.6 billion in False Claims Act (FCA)[1] settlements and judgments. Of that amount, more than $5 billion [2] resulted from matters involving
Civil Investigative Demands (CIDs) & Collateral Enforcement Risks: A Review Read More »
(October 3, 2022): Aquatic therapy is a common method of rehabilitation and maintenance for several types of injuries and conditions, and the practice is widely accepted by Medicare, Medicaid and many private payors. Historically, both payors and law enforcement have routinely audited aquatic therapy claims. The Centers for Medicare and Medicaid Services (CMS) initially suspended
Enforcement Efforts Targeting Aquatic Therapy Providers and CPT Code 97113 Claims Read More »
(September 20, 2022): In the Medicare billing context, the term “Incident To” refers to the fact that under certain circumstances, the services of non-physician, mid-level practitioners (such as Nurse Practitioners (NPs) and Physician Assistants (PAs)) are “. . . furnished as an integral, although incidental, part of the physician’s personal professional services in the course
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