Susan Feigin Harris
Co-Head of Healthcare, United States
Norton Rose Fulbright US LLP
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Biography
Susan Feigin Harris leads the NRF Healthcare practice group in the US with her Partner and friend, Stacey Murphy. Susan has established a national practice which, in more recent years has distinguished itself with experience in the unique needs of children's hospitals, including the special reimbursement and financial aspects of Medicaid funding in states, such as Medicaid supplemental payment programs, Medicaid state directed payment programs, Children's Hospital Graduate Medical Education (CHGME) funding, and Medicaid managed care arrangements.
Named 2018 Texas Lawyer of Year by Texas Lawyer, Susan has a long history of focusing upon the unique and strategic needs of her provider-based clients. Susan began her legal career with a focus on hospital and physician reimbursement issues and has grown her practice to include the operational, regulatory, business, corporate, governance, compliance and contracting needs for a diverse group of healthcare clients. She regularly provides advice to sophisticated academic medical center entities addressing the unique needs involving residency training programs, research and grant compliance, federal and state healthcare policies, and works with state and federal healthcare agencies involving Medicare and Medicaid certification and enforcement initiatives. Susan's clients include hospitals, physician groups, telehealth, lab companies, post-acute providers and healthcare innovations companies.
Additionally, Susan frequently provides strategic advice to top-level executives and general counsel alike regarding healthcare funding initiatives and healthcare policy at the state and federal level, working to help craft legislative language. She is responsible for crafting Medicaid statutory language involving Medicaid managed care out of network payments in Texas, Medicaid funding, graduate medical education funding and at a federal level, the Advancing Care for Exceptional Kids (ACE) Kids Act passed as part of the Consolidated Medicaid Services Investment and Accountability Act of 2019 (P.L. 116-16).
This work has led to the creation of several accountable care organizations (ACOs), including the development of patient-centered medical homes, care coordination entities and other clinically-integrated networks (CIN).
Susan regularly reviews and negotiates commercial and government payment managed care contracts, including compliance with marketing, and downstream contracting provisions.
Susan's experience includes counseling clients on Medicare and Medicaid compliance issues, Civil Investigative Demands (CID), Requests for overpayments and other payment disputes involving government program enforcement entities.
In particular, Susan is well-known for her knowledge of issues, development of pragmatic programmatic solutions, implement legislative and advocacy strategies and bringing a multi-dimensional set of problem-solving skills to client representation.
Professional experience
Collapse all- JD, University of Houston Law Center, 1988
- BA, public policy studies and history, with honors, Duke University, 1985
- Texas State Bar
- Represents several clients in development of pediatric accountable care organization (ACO), patient centered medical homes (PCMH), and clinically integrated networks (CIN) including drafting and implementing provider contracts and management service agreements with Medicaid managed care organizations (MCOs). Provides strategic counseling in establishment of care coordination programs, and operational needs.
- Counsel large hospital system on Medicaid supplemental payment and state directed payment program funding options with the state and CMS. Work with government relations and system executives to craft legal options for creation of additional Medicaid funding mechanisms and quality improvement programs.
- Provide counsel and defend requests for Medicaid and Medicare overpayment or recoupment notices. Work with multiple representatives and coordinating large groups of lawyers and hospital system representatives and coordinating groups of constituencies in multi-party litigation.
- Defend clients involving multiple Civil Investigative Demands (CIDs) and Medicaid Office of Inspector General (OIG) notices, often involving technical reimbursement and coverage issues, coding and compliance concerns and conflicting legal directives.
- Represent provider-based MCO in pursuit of Medicaid managed care contract, contract negotiations with state agencies and dispute resolution.
- Represent provider-based MCOs in relation to development of operational programs to ensure appeals and grievances and other compliance issues are appropriately addressed in compliance with Medicaid contract and Medicaid managed care rules.
- Worked with clients to analyze graduate medical education (GME) and children's hospital graduate medical education (CHGME) payment; review cost report and affiliation agreement provisions; work to renegotiate and draft affiliation agreement provisions relative to the sponsoring entity.
- Involvement with closure of residency training programs and relocation of residents to other sponsoring institutions.
- Work with several private equity-backed telehealth companies to ramp up telehealth services for coronavirus testing and provision of services in multiple states. Managed the Medicaid and Medicare enrollment, billing, and compliance issues; work with state agencies to comply with testing and other waivers for COVID-19.
- Provide guidance to several clients regarding audits and CARES Act Provider Relief Fund attestation and payments.
- Worked with CMS and HHS to obtain funding formula for clients under Provider Relief Fund reflective of Medicaid patients treated.
- Represented 12 of the nation's largest children's hospitals in securing a nationally significant Medicaid reimbursement litigation win in multiple district courts and several courts of appeals against the government for improperly promulgating a Medicaid policy and for pursing informal guidance as though it was policy. Since 2014, these hospitals, and many others were denied tens of millions of dollars of DSH Medicaid funding.
- Secured an appellate victory for two hospitals. The US Court of Appeals for the Eighth Circuit affirmed a district court order enjoining the defendants, the administrator for the Centers for Medicare & Medicaid Services (CMS) and the secretary of the US Department of Health & Human Services (HHS), from enforcing a Medicaid policy set forth in a frequently-asked-questions document (FAQ 33).
- Represented a large reference laboratory in obtaining reinstatement of a CLIA license and restricting the arrangement with pathology practices for purposes of moving forward with innovative laboratory testing services.
- Represented a unique coalition of the United States' largest freestanding children's hospitals to develop special national network options in Medicaid policy for children with complex conditions including legislative language; draft responses to specific legislative interest by Congress, the Congressional Budget Office, and the CMS; and claims and data development. Authored legislation introduced in the US Congress through two congressional sessions, including advocating for clients, working with legislative counsel, and advising a trade association on changes to statutory language and policy impact.
- Successfully obtained multiple injunctions on behalf of multiple children's hospitals in dispute with CMS over disproportionate share hospital (DSH) reimbursement disputes in multiple states, including Minnesota, Virginia, Texas, and Washington.
- Represented clients before federal appeals courts in DSH administrative law disputes with CMS.
- Work with several healthcare trade associations in lobbying and development of health policy initiatives, including the nation's major pediatric trade association in efforts to reauthorize the children's graduate medical education program and support Medicaid and other children's hospital initiatives.
- Created intergovernmental transfer (IGT) arrangements under the state Medicaid upper payment limit statute for graduate medical education.
- Served as a strategic partner and a lead in negotiations with a state Medicaid program to create a care coordination and accountable care entity. Created and negotiated all provider contracts and subcontracts; helped establish and create shared savings formulas; and worked to facilitate and negotiate a contract with the state agency.
- Represented clients in Congress during the passage of the ACA, specifically relating to DSH funding, Medicaid reimbursement, pediatric accountable care organization development, and other potential workforce funding opportunities. Established meetings with key congressional members and analyzed, counseled, and drafted alternatives to legislative language.
- Facilitated an interface with Center for Medicare and Medicaid Innovation (CMMI) officials relating to the consideration of differing sites of service for certain cardiac catheterization procedures as a means to increase quality outcomes while saving costs. Advised the client on grant proposals submitted to the CMMI.
- Analyzed and created multiple hospital-within-hospital arrangements and worked with Medicare fiscal intermediaries to maintain or obtain such certification.
- Handled Medicare and Medicaid licensing and certification issues associated with multiple changes of ownership.
- Analysis of Medicare Part A cost report reimbursement denials and pursuit of claims before the CMS Provider Reimbursement Review Board (PRRB).
- Provided analysis and knowledge relating to managed care narrow network issues, including out-of-network usage nationally.
- Provided analysis and guidance relating to health insurance fraud laws.
- Consulted on issues associated with research compliance, residency training programs, and other issues specific to academic medical centers.
- Counseled hospitals relating to drug diversion and similar CMS conditions of participation compliance issues.
- Recognized for Healthcare: Texas Band 1, Chambers USA, 2019–2023
- Houston Business Journal, 2022 Women Who Mean Business Honoree
- Recommended in Industry focus: Healthcare: service providers, The Legal 500 US, 2019–2021
- Recognized as a Healthcare/Life Sciences Trailblazer, The National Law Journal, 2021
- Named an MVP in Health, Law360, 2015 and 2018
- Named Litigator of the Week, The Am Law Litigation Daily, 2018
- Recognized as Attorney of the Year, Texas Lawyer, 2018
- Recognized for Healthcare: Texas, Chambers USA, 2011–2018
- Named Lawyer of the Year, Best Lawyers, 2017
- Best Lawyers - Government Relations Practice, Best Lawyers, 2016 - 2020, 2022 - 2024
- Best Lawyers - Health Care Law, Best Lawyers, 2006 - 2024
- Best Lawyers Texas - Government Relations Practice and Health Care Law, 2022
- Legal 500 US, Recommended Lawyer, Education, The Legal 500, 2023
- Legal 500 US, Recommended Lawyer, Healthcare: Service providers, The Legal 500, 2023
- Recognized by Texas Super Lawyers, 2008–2021
- Included in Top 50 Women, 2009, 2011 and 2012; Top 100 Lawyers, 2011 and 2012, Texas Super Lawyers
Co-Author, “Medicaid and CHIP Managed Care Final Rule: But wait, there is more”, Norton Rose Fulbright Legal Update, May 2024
Author, “Medicaid Managed Care Final Rule: Long-awaited pronouncement on permitted uses of state directed payments”, Norton Rose Fulbright Legal Update, April 2024
Co-Author, “A first look at the Medicare FY 2025 IPPS proposed rule”, Norton Rose Fulbright Legal Update, April 2024
Author, “Medicaid final rule implements hospital specific DSH limit change”, Norton Rose Fulbright Legal Update, February 2024
Co-Author, “HHS and CMS to issues series of EMTALA guidance notices applicable to hospitals and patients”, Norton Rose Fulbright Legal Update, February 2024
Co-Author, “Site neutrality gains steam with House passed Lower Costs, More Transparency Act”, Norton Rose Fulbright Legal Update, December 2023
Co-Author, “CMS issues interim rule addressing Medicaid disenrollments effective immediately”, Norton Rose Fulbright Legal Update, December 2023
Co-Author, “Healthcare Regulation 2024: Getting the Deal Through”, Lexology, November 2023
Co-Author, “The No Surprises Act: New FAQs and IDR portal reopening”, Norton Rose Fulbright Legal Update, October 2023
Co-Author, “US FTC is dealt a blow by Louisiana District Court in acquisition challenge of Children’s Medical Center”, Norton Rose Fulbright Legal Update, October 2023
Co-Author, “Texas federal court again strikes regulations implementing the No Surprises Act”, Norton Rose Fulbright Legal Update, September 2023
Co-Author, “88th Texas Legislature: 2023 Healthcare legislative update”, Norton Rose Fulbright Legal Update, July 2023
Author, “FTC withdraws longstanding healthcare policies”, Norton Rose Fulbright Legal Update, July 2023
Co-Author, “HHS FAQs puts spotlight on facility fees”, Norton Rose Fulbright Legal Update, July 2023
Co-Author, “US CMS propose 340B remedy for CY 2018-2022”, Norton Rose Fulbright Legal Update, July 2023
Author, “Medicaid update: Texas v. Brooks-LaSure”, Norton Rose Fulbright Legal Update, July 2023
Co-Author, “CMS steps up hospital price transparency enforcement”, Norton Rose Fulbright Legal Update, May 2023
Author, “The two Texas lawsuits that could impact access to healthcare”, Norton Rose Fulbright Legal Update, April 2023
Author, “CMS propose impactful policy changes to Medicare and Medicaid DSH”, Norton Rose Fulbright Legal Update, March 2023
Co-Author, “Antitrust ‘safety zone’ withdrawal: ACO compliance considerations”, Norton Rose Fulbright Legal Update, February 2023
Co-Author, “Life after the public health emergency rules”, Norton Rose Fulbright Legal Update, February 2023
Author, “US DOJ eliminates healthcare ‘antitrust safety zones’”, Norton Rose Fulbright Legal Update, February 2023
Co-Author, “Hidden gems in the CMS 2024 Medicare Advantage proposed rule”, Norton Rose Fulbright Legal Update, January 2023
Co-Author, “Medicaid at the Supreme Court: Talevski and enforcement of beneficiary rights”, Norton Rose Fulbright Legal Update, November 2022
Author, “A first look at the Medicare CY 2023 OPPS and ASC proposed rule”, Norton Rose Fulbright Legal Update, July 2022
Co-Author, “A first look at the Medicare CY 2023 Physician Fee Schedule Proposed Rule”, Norton Rose Fulbright Legal Update, July 2022
Co-Author, “CMS issues clarifying EMTALA memorandum in the wake of Dobbs”, Norton Rose Fulbright Legal Update, July 2022
Author, "Becerra v. Empire Health: US Supreme Court grapples with Medicare DSH formula", Norton Rose Fulbright Legal Update, July 2022
Co-Author, "Win for hospitals: Unanimous SCOTUS overturns 2018 and 2019 340B drug reimbursement cuts”, Norton Rose Fulbright Legal Update, June 2022
Co-Author, "Operational challenges of the No Surprises Act continue to surprise providers”, Norton Rose Fulbright Legal Update, June 2022
Co-Presenter, “The Expanding Role of Medicaid Managed Care”, AHLA Institute on Medicare and Medicaid Payment Issues Conference, March 2024
Co-Presenter, “88th Texas Legislature: 2023 Healthcare legislative update”, Norton Rose Fulbright Webinar, August 2023
Co-Presenter, “Antitrust safety zone withdrawal: Information exchange compliance considerations”, Norton Rose Fulbright Webinar, April 2023
Co-Presenter, “Answering questions raised by the No Surprises Act”, Norton Rose Fulbright Webinar, June 2022
- Board Certified in Health Law, Texas Board of Legal Specialization
- Member, Healthcare Editorial Advisory Board, Law360, 2018–2022
- Member, American Health Lawyers Association, AHLA; formerly served as vice-chair, In-House Counsel Practice Group, and founding co-chair, AHLA Children's Hospital Affinity Group
- Member, Houston Bar Association; founding member, Health Law Section
- Director, Texas Lyceum
- Medical Class 2 Senior Fellow, American Leadership Forum
- Member, American Bar Association
- Former adjunct professor, University of Houston Law Center
- Supreme Court of the United States
- US Court of Appeals for the Fourth Circuit
- US Court of Appeals for the Eighth Circuit
- US Court of Appeals for District of Columbia Circuit
- US District Court for the Southern District of Texas
- Supreme Court of Texas
Insights
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Medicaid Managed Care final Rule
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