- Fraud & Abuse, Compliance & Regulatory Counseling
- Medicare, Medicaid & Commercial Payor Coverage & Payment
- Mergers, Acquisitions & Other Transactions
- State & Federal Audits, Investigations & Litigation
- Israel Business Group
- Health Law
- Health Care
- Professional Services
|Contact Info||Telephone: 202.661.8715|
Internet: Each Attorney's Internet Address takes the following form: first initial, last name @mintz.com (e.g., email@example.com)
|University ||University of Rochester, B.A., 1982|
|Law School||Columbia University, J.D., 1985|
|Admitted||1986, New York; 2000, District of Columbia|
Susan is Managing Member of the firm's DC office, and she also serves on the firm's Policy Committee. Her practice focuses on advising private and public health care service providers, including managed care organizations, pharmaceutical services providers such as PBMs, behavioral health companies, specialty care companies, and integrated delivery systems, often in the context of strategic affiliations and complex service agreements.
Susan has advised some of the nation's largest government health programs and has negotiated some of the nation's largest pharmacy service agreements, and also advises on complex mergers, acquisitions, joint ventures, and network development programs. She regularly represents pharmacy benefit manager (PBM) clients and their related mail order/specialty pharmacies in connection with the drafting, negotiation, structuring, and health care regulatory analysis of rebate agreements, drug purchase agreements, distribution agreements (including specialty drug distribution agreements), wholesaler agreements, repackaging arrangements, GPO arrangements and private label arrangements. She also has significant experience assisting venture capital groups and investment banks with investments in the health care industry.
Susan's experience also includes advising Medicare Advantage Organizations (MAOs) and Medicare Part D Plan Sponsors, including Employer Group Waiver Plans (EGWPs), and first tier and downstream entities to address regulatory and compliance matters that arise as a result of participating in Medicare Parts C and D. She frequently counsels clients on risk adjustment programs and the practices needed to support them. She also develops and negotiates a variety of contracts needed to establish and support Medicare Advantage Plans, Part D Plans., and health plans intending to participate in state exchanges.
Susan returned to Mintz Levin in 2008 after a two-year hiatus, during which she served as general counsel of the Public and Senior Markets Group at UnitedHealth Group, a Fortune 20 company and one of the nation's leading managed care organizations. In this role, she was responsible for the legal and regulatory oversight of UnitedHealth's government programs (including Medicare and Medicaid) and was also the chief legal counsel for all pharmacy services.
Other aspects of Susan's practice focus on a broad spectrum of state and federal regulatory laws unique to the health care industry, and the application of such laws to the structuring and execution of complex business arrangements. She regularly advises clients on such issues as federal and state anti-kickback and self-referral laws; emerging developments in health care legislation, including, most recently, the Affordable Care Act and the Mental Health Parity and Addiction Equity Act; and state regulatory issues, such as corporate practice of medicine and fee-splitting prohibitions.
Susan practiced in New York for many years before moving to Washington, DC.
· Counseled a full-service pharmacy benefit manager (PBM) and its affiliated companies in a merger with another pharmacy benefit management company, and served as lead counsel on the drafting and negotiation of related transaction documents between the parties, including ancillary services agreements and transition agreements
· Counseled a global health care company in connection with its acquisition of health plans and provider groups; work included health regulatory due diligence in more than several health plan acquisitions and health regulatory advice regarding transaction structure and strategy, regulatory notices, and other filings
· Counseled a large pharmacy benefit manager (PBM) in its negotiation of a PBM services agreement with a global health insurance company
Recognitions & Awards
· Chambers USA: District of Columbia - Healthcare (2013)
· Harlan Fiske Stone Scholar at Columbia University
· Phi Beta Kappa
Documents by this lawyer on Martindale.com
CMS Issues Final Call Letter for 2015
Roy M. Albert,Susan W. Berson, April 11, 2014
Earlier this week, CMS announced in its Final Call Letter that Medicare Advantage rates would rise an average of 0.4 percent in 2015, instead of falling 1.9 percent as proposed in February. CMS’s shift in course may stem from the 1300 comments the agency received in response to...
Notice to Plans and PBMs: Pay for Contraceptive Services and Maybe We Will Pay You Back
Susan W. Berson,Tara E. Swenson,Bridgette A. Wiley, February 19, 2014
As has been widely covered in the news, regulations and guidance developed under the Affordable Care Act (“ACA”) require that non-grandfathered health plans make preventive care and screenings available to their members at no cost (i.e. no deductibles, coinsurance, or co-payments). The...
Final Mental Health Parity Rules Released
Susan W. Berson,Bridgette Wiley, November 14, 2013
The Departments of Health and Human Services, Labor, and the Treasury jointly issued a long-awaited final rule that implements the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The final rule decreases the differences between mental health...
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