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Health Care 2010: Managing Risks in the New Compliance and Enforcement Environment

Author(s): Susan W. Berson, Ellen J. Flannery
Practice Area: Health Care
Published: Apr 2010
ISBN: 9781402413896
PLI Item #: 23300
CHB Spine #: M1

Susan is Managing Member of the firm’s Washington, D.C. office. She returned to Mintz Levin after a two-year hiatus, during which she served as General Counsel, Public and Senior Markets Group of 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 United’s government programs (including Medicare and Medicaid) and was also the chief legal counsel for all pharmacy services. Susan successfully established a strategically organized legal and regulatory affairs team that included a first-rate litigation and risk management team, a robust audit management team and a national compliance team, each dedicated to addressing the many needs of government-sponsored programs. Prior to her experience at UnitedHealth Group, Susan practiced as a member at Mintz Levin for six years, where she was the head of the Health Law practice, and before that practiced in New York for many years.

As a member of the Health Law practice, Susan focuses on advising private and public health care service providers, including those in the managed care, device, diagnostic and pharmaceutical sectors, often in the context of affiliation and service agreements, including some of the nation’s largest pharmacy service agreements, mergers, acquisitions, joint ventures and network development programs. She also advises venture capital groups and investment banks on investment in health-related businesses.

Susan’s representation focuses 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 health care clients on such issues as federal and state anti-kickback and self-referral laws; emerging developments in health care legislation; privacy, including compliance with HIPAA; state regulatory issues such as corporate practice of medicine and fee-splitting prohibitions; the negotiation of managed care arrangements and service contracts with providers and facilities and the development, implementation and enforcement of compliance programs. Some of Susan’s recent work includes the structuring and negotiation of mergers and acquisitions involving government programs, the negotiation of rebate and pharmacy benefit service contracts, both in the commercial, Medicaid and Part D context; the structuring of disease management and other managed care programs, the structuring of incentive payment arrangements; and the negotiation of service and network contracts for a variety of health care related companies.

Susan practiced in New York for many years before moving to Washington. She is a Phi Beta Kappa, magna cum laude graduate of the University of Rochester and received her J.D. from Columbia University School of Law, where she was a Harlan Fiske Stone Scholar.