Robert W. Liles, J.D., M.B.A., M.S.

Robert W. Liles has worked in health care since 1984, first in hospital administration and later in health law (as a federal prosecutor and as defense counsel). This has provided a unique perspective on the challenges faced by health care providers. Robert focuses his practice on fraud defense, internal audits / investigations and compliance and regulatory matters. He has represented a wide variety of health care providers 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 health care management after receiving a Master’s Degree in Health Care Administration. He subsequently attended law school and 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” for the Executive Office for U.S. Attorneys (EOUSA), a component of the United States Department of Justice (DOJ). He was detailed to Washington, DC where he advised AUSAs around the country on civil and criminal health 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 was subsequently promoted and served as Deputy Director for Legal Programs at EOUSA. While with DOJ, Robert was recognized and 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 EOUSA.
Since entering private practice, Robert has continued to build on his health care background and experience. He has represented physicians, home health agencies, hospices, durable equipment suppliers and third-party billing companies around the country in a wide variety of regulatory, audit and compliance projects. He has also represented physicians and other health care providers in connection with government investigations, overpayment audits by Zone Program Integrity Contractors (ZPICs), Supplemental Medical Review Contractors (SMERCs), Recovery Audit Contractors (RACs) and reviews by Special Investigative Units (SIUs) working for private payor plans.
Robert is a nationally-recognized speaker and educator on health law 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 Department of Health and Human Services, Office of Inspector General (HHS-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 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 health care related associations 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 for a non-hospital program for 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 extensive experience working in the area of health law provide a real-world perspective when advising health care providers and durable medical equipment suppliers on enforcement and regulatory compliance issues.