Susan Banks

Susan Banks is a healthcare attorney in Holland & Knight's Denver office. Ms. Banks focuses her national practice on advising hospitals, health systems and other healthcare providers and suppliers on the full range of Medicare and Medicaid compliance and reimbursement issues. She also helps clients navigate the complexities of healthcare delivery reform and inevitable operational challenges amid the ever-evolving federal regulatory environment.

A core part of Ms. Banks' practice involves counseling clients around potential federal healthcare program overpayments, including analysis of conditions of payment, risk assessments, design and oversight of internal investigations, coordination of payment audits, and development of disclosure and refund strategies, when needed. Clients appreciate her organized and down-to-earth, nonalarmist approach to evaluating potential overpayments and mitigating risk. Ms. Banks' versatile, practical and business-oriented strategies help clients resolve potential exposure collaboratively and proactively.

Ms. Banks has deep experience and knowledge regarding Medicare reimbursement mechanisms, including the various prospective payment systems and fee schedules, associated coverage policies, and billing rules for various items and services. Her recent engagements have included advising clients regarding Medicare cost-reporting rules, outpatient physician supervision requirements, billing for services furnished by mid-level practitioners, medical necessity of inpatient admissions, inpatient admission order requirements, rules to qualify for provider-based status and related billing and payment rules, scope of the diagnosis-related group (DRG) three-day payment window, and appropriate uses of advance beneficiary notices (ABNs) and hospital-issued notices of noncoverage (HINNs).

In addition, Ms. Banks has extensive experience with graduate medical education (GME) reimbursement and contracting requirements, as well as with the establishment of new medical and dental residency programs. She also advises clients on the requirements for participating in the 340B Drug Discount Program.

Ms. Banks assists clients in conducting internal investigations of compliance and reimbursement matters and, when appropriate, making self-disclosures and voluntary refunds. She also has experience advising and representing clients in government investigations and civil and criminal litigation involving allegations of fraud and abuse arising under the federal False Claims Act (FCA), Stark Law and Anti-Kickback Statute (AKS). Ms. Banks has represented clients in connection with investigations and audits undertaken by federal and state regulatory and enforcement agencies, including the U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Centers for Medicare & Medicaid Services (CMS) and its contractors, and Health Resources and Services Administration (HRSA).

Ms. Banks regularly drafts comment letters for submission to various state and federal administrative bodies on behalf of her clients. She also assists providers in filing appeals with the Provider Reimbursement Review Board (PRRB) and participates in administrative hearings before the board.

Prior to joining Holland & Knight, Ms. Banks was a healthcare attorney for a global law firm in its Denver office, and spent five years in private practice in Washington, D.C., before that.

Ms. Banks also has served as an adjunct faculty member at the University of Virginia School of Law, teaching a Medicare Practice Seminar and Medicare Coverage, Payment and Compliance course between 2017 and 2020.