Robert Mazer represents clinical laboratories, hospitals, and other health care providers in connection with payment, compliance and regulatory issues.
Mr. Mazer advises health care providers on a broad range of payment and compliance issues, including Medicare, Medicaid and other third-party payment rules, the Federal Anti-kickback Statute, the Eliminating Kickbacks in Recovery Act (EKRA), the Stark Law, and the Clinical Laboratory Improvement Amendments of 1988 (CLIA). He also represents clients with related disputes with government agencies, CMS contractors and private insurers.
Mr. Mazer has extensive experience with legal, regulatory and business issues related to clinical laboratory and anatomic pathology services, including genomic testing such as pharmacogenetic tests. He assists clients with billing, discount and pricing issues, medical necessity and related documentation requirements, lab-to-lab referrals and reference lab agreements, the 70/30 or shell lab rule, issues raised by out-of-network status, including waiver of coinsurance or copayments and deductibles, TC/PC billing, laboratory director contracts, and management contracts, leases and other financial arrangements with physicians, hospitals and other referral sources. He also defends companies facing government investigations and those who are parties to regulatory or payment disputes, including recoupment actions based on medical necessity determinations or other payment requirements and CLIA sanctions. Mr. Mazer is experienced in assisting laboratories in responding to survey determinations of condition-level deficiencies under CLIA, such as findings related to impermissible proficiency testing (PT) referrals and has pursued administrative appeals on their behalf when necessary. He has successfully defended CLIA revocation actions, including those based on allegations of improper referrals of PT samples.
Mr. Mazer has significant experience before the Provider Reimbursement Review Board (PRRB) and in related federal court actions. His financial background, including prior service on the AICPA committee that develops the Audit and Accounting Guide for Health Care Organizations, provides Mr. Mazer with a substantial knowledge base regarding accounting principles, cost computations and fair market value determinations.
Mr. Mazer has co-authored compliance manuals related to Medicare fraud and abuse prohibitions, generally, and the Stark Law, specifically. He has also contributed chapters on legal issues related to clinical laboratory testing and on CLIA, and coding and payment principles applicable to laboratory and pathology services.
A frequent lecturer and author, Mr. Mazer has spoken at conferences sponsored by the American Institute of CPAs, Clinical Laboratory Management Association, American Health Law Association, Health Care Compliance Association (HCCA), and Washington G-2 Reports. Mr. Mazer served as the coordinator of the Laboratory Immersion Session for HCCA's Compliance Institute sponsored by the Health Care Compliance Association and addressed clinical laboratory issues at the 2019 Compliance Institute. He is also manager of the Laboratory Legislation Regulation group on LinkedIn.
Mr. Mazer serves on the adjunct faculty at the University of Maryland Carey School of Law teaching Health Care Business Arrangements.