Mary Susan Philp

Susan Philp is senior counsel in Powers Pyles Sutter & Verville's healthcare group.

Susan has more than 30 years of experience in Medicare and Medicaid reimbursement and compliance matters. With her years of experience and in-depth legal knowledge, Susan is able to assist clients, including hospitals, home health agencies, physicians, clinical and histocompatibility laboratories, organ procurement organizations, and other healthcare providers and suppliers, in quickly identifying relevant issues and achieving efficient and prompt resolution.

Susan works with clients to ensure that they meet all federal and state regulatory requirements and helps them obtain accurate Medicare and Medicaid reimbursement. She is highly skilled in representing clients before the Provider Reimbursement Review Board on a variety of reimbursement issues, as well as negotiating settlements of appeals with Medicare administrative contractors. She has extensive knowledge of Medicare Parts A and B coverage, billing and payment rules and regularly advises clients regarding compliance with these rules.

Susan has been a frequent lecturer and author on healthcare legal issues, particularly in the areas of reimbursement and fraud and abuse, and is a contributing author for the American Health Lawyers Association's Health Law Practice Guide.

Additionally, Susan has:

• Represented numerous hospitals before the PRRB in individual and group appeals involving wide range of issues, including disproportionate share payment, graduate medical education and indirect medical education, rural floor budget neutrality adjustment, bad debts, organ acquisition costs, allied health education, and others.
• Negotiated settlement for hospital with U.S. Attorney and U.S. Department of Health and Human Services Office of Inspector General of False Claims Act allegations involving DRG upcoding.
• Successfully represented hospital in defending FCA investigation relating to use of non-FDA-approved medical devices.
• Advised major health system regarding application of Medicare provider-based rules to multi-campus hospitals and clinics.
• Represented and negotiated settlement for consulting firm in FCA investigation relating to cost report reimbursement advice.
• Represented organ procurement organization and histocompatibility laboratories in reimbursement appeals before intermediary hearing officers and CMS.
• Advised hospitals and other providers regarding anti-kickback statute implications of various transactions and practices.