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About Susan
Susan Banks is a health care reimbursement and compliance attorney who advises hospitals, health systems, physicians and other providers and suppliers on complex Medicare and Medicaid payment and regulatory matters.
She works closely with legal, compliance and finance teams to navigate the intricacies of federal health care program reimbursement and compliance. She brings a practical, solutions-oriented approach to helping clients address regulatory challenges and tackle operational obstacles strategically.
Susan’s practice includes:
- Advising on Medicare and Medicaid payment systems, coverage and billing rules, reimbursement mechanics and payment requirements;
- Assisting clients with identification, investigation and resolution of potential overpayments, including development of audit plans and self-disclosure and refund strategies;
- Conducting risk assessments and overseeing internal investigations related to compliance and reimbursement matters;
- Advising covered entities on enrollment and compliance requirements under the 340B Drug Pricing Program;
- Working with teaching hospitals, academic medical centers, training sites and program sponsors to support graduate medical education (GME) operations, compliance and reimbursement;
- Representing clients in program integrity audits (UPICs, RACs, SMRCs, CERTs and others), government investigations and enforcement actions;
- Counseling and developing strategies to comply with and mitigate risk under the Physician Self-Referral Law (Stark Law), Anti-Kickback Statute and the False Claims Act; and
- Assisting providers with administrative appeals and litigation, including Medicare claims appeals before the MAC, QIC and ALJ, cost report appeals before the Provider Reimbursement Review Board (PRRB) and rulemaking challenges in federal court.
Susan regularly supports clients through complex audit and enforcement processes and routinely interfaces with federal and state agencies on her clients’ behalf, including the Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), Department of Health and Human Services Office of Inspector General (HHS OIG) and the Department of Justice (DOJ).
