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Liles Parker Attorney Presented at the West Virginia Physician Summit.

August 26, 2013 by  
Filed under Firm News

Liles Parker attorney presented at the West Virginia Physician Summit.(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 keynote speaker at the plenary session of the West Virginia Medical State Association’s annual conference.  The 2013 West Virginia Physician Summit was conducted at the historic “Greenbrier,” located in White Sulphur Springs, West Virginia.  As Robert’s presentation discussed, it is more important than ever that physicians identify and address any Medicare compliance risks facing their practice. Robert’s presentation outlined the following physician, practice group, and Medicare compliance challenges:

Risk #1: ZPIC / RAC / MAC Post-Payment Audits of Physician Claims Billed to Medicare.

Risk #2: Increased Likelihood of Pre-Payment Reviews by ZPICs.  Plus, RAC Pre-Payment Reviews are Now Here.  Rise of the UPICs!

Risk #3: Increased Possibility of Criminal Referral, Suspension or Revocation Action Recommended to CMS by ZPICs and RACs.  

Risk #4: Increased Risk of Statutory Violations Due to Changes Under the Affordable Care Act (ACA).

  •  Failure to return overpayments within 60 days.
  • Loosening of proof standards to show a violation of the Federal Anti-Kickback Statute.
  • Expansion of the Medicare permissive exclusion rules.
  • Importance of Medicare Compliance.

Risk #5: Increased Prosecutions by HEAT Teams Around the Country.

Risk #6: Increased Sanctions and Level of Risk Associated with Violations of HIPAA and/or HITECH Privacy Requirements.

Risk #7: Increased Collection and Investigative Activity by Private Payor SIUs.

Risk #8: Increased Enforcement by HHS-OIG of CMP Actions for Failure to Screen Employees.

Risk #9: Increased Audit and Investigative Actions by MFCUs, MICs and Medicaid RACs.

Risk #10: Increased likelihood of Qui Tam and/or Government False Claims Act cases against Providers. 

In addition to the Medicare Compliance risks outlined above, Robert discussed the importance of conducting a “Gap Analysis” so that any deficiencies (in coding, billing or in business practices) could be identified and remedial steps could be taken, thereby bringing a practice into regulatory alignment with Medicare Compliance mandates. Is your practice currently facing a pre-payment review or a post-payment audit, please give us a call so we can discuss your options for responding to the CMS contractor’s actions.

Robert W. Liles is a health care attorney experienced in handling prepayment reviews and audits.Robert W. Liles serves as Managing Partner at the law firm, Liles Parker, PLLC (Liles Parker).  Our firm is a boutique health law firm with offices in Washington, DC, Houston, TX, McAllen, TX and Baton Rouge, LA.  We represent physicians, group practices and others health care providers around the country in connection with statutory and regulatory health care issues that may arise.   For a complimentary consultation, please give us a call at:  1 (800) 475-1906.

Robert W. Liles Participates in Meeting with Congressman Culberson and Health Care Association Representatives in Houston

April 8, 2010 by  
Filed under Firm News

(April 8, 2010): On Wednesday evening, April 7, Robert W. Liles, Managing Member of the Firm, met with Congressman John Culberson and a group of  state and local medical association executives to discuss the recent passage of the health care reform bill.  Congressman Culberson heard from the participants, noting their views of how this legislation is going to impact Texas physicians and hospitals.  Mr. Liles discussed several provisions of the bill aimed at increasing health care fraud enforcement efforts.   He also discussed the current ZPIC audits being conducted in Texas by Health Integrity, a Medicare contractor.   The event was held at the Harris County Medical Society’s headquarters in downtown Houston.

Providers were understandably worried about the situation at hand. The Federal government’s recent emphasis on combating health care fraud and abuse – establishing nationwide RACs, ZPICs and HEAT teams in just the past year – has left hospitals, physicians and other health care providers in a state of panic. Audits of Medicare and Medicaid claims have been ramped up significantly, while Medicare reimbursement rates have been cut. While the deck seems stacked against health care providers, remember that providers themselves have a number of important rights under existing statutes, including rights for appealing denied claims. In this new environment though, it is imperative that health care providers accurately and appropriately document their services and that they use experienced and trained billers to process their Medicare claims.

If you would like more information on this meeting or the services of Robert W. Liles, please call us at: 1 (800) 475-1906 or send an email to