Dr. Susan Hayes
Principal
Criminologist, Health Care Fraud Investigator, Educator
Accredited Healthcare Fraud Investigator, Certified Pharmacy Technician, Licensed Private Investigator (IL License Number 115.002527 and WA License Number 21023320)
Phone: (847) 540-9590 ex 102
Email: Susan.Hayes@pharmout.com
Susan has over 40 years’ experience in the health care consulting, pharmacy benefit management industry. As a founder of Pharmacy Investigators and Consultants (PIC), a Women’s Business Enterprise (WBE) and co-founder of Pharmacy Outcomes Specialists (POS), its predecessor firm, Susan is responsible for the strategic direction of the firm and specific sales, proposal, product pricing and development. Susan is a lead project manager for the firm’s clients, which include McKee Foods, Meridian Health Plan and UNITE HERE HEALTH and many other government, managed care, pharmacy benefit managers (PBMs) and hospital/clinical organizations. In her many years in the pharmacy benefits and health care anti-fraud industry, Susan has developed a broad understanding of criminological theory application to fraud and investigation techniques and enhancements. Susan specifically specializes in analytics and Big Data combinations to solve issues. Both of her inventions, the COPsTM and CARsTM systems are trademarked.
Simultaneous to her role at PIC, Susan is the Director and Assistant Professional Practice Professor of the Health Informatics Master’s Degree Program for Roosevelt University where she oversees approximately 100 students’ progress, develops curriculum and teaches core courses. Of the twelve courses in the program, she teaches five courses including “Ethics and Health Informatics Law” and “Health Behavior Theory.”
Prior to POS, Susan was Vice President of Marketing for Systemed Pharmacy, Inc. and Vice President, Marketing of Walgreens Healthcare Plus. In both positions, she was responsible for the strategic development of the target market and product mix for PBMs, growing retail and mail service revenues and enhancing overall client retention. For five years prior to Walgreen Co., Susan was the National Practice Leader for William M. Mercer, Inc., specializing in prescription drug auditing and bid procurement. Clients included Fortune 500 employers.
She has published several articles in Business Insurance and Employee Benefit News and authored several academic articles. She was a featured expert in a 2025 documentary, “Side Effects May Include: The Hidden Costs of Prescription Drug Programs.” In 2025, she also provided a chapter on healthcare crimes in a textbook, “White Collar Crime: A Practitioner’s Perspective.” Susan has provided expert witness services to many key legal cases. Most notably, Susan was one of two experts in Rutledge vs. PCMA, providing key information that both informed and formed the winning opinion in the case, heard by the United States Supreme Court. She was also the key expert in Garbe v. Kmart, involving pharmacy payment and adjudication issues. Susan is a strong advocate for community pharmacists and transparency. Susan has testified to the Committee on Oversight and Government Reform, Subcommittee on Federal Workforce, Postal Service and the District of Columbia on Transparency in the PBM Industry and several times to the Department of Justice.
Susan has a Bachelor of Science Degree in criminal justice from Northeastern Illinois University and a master’s degree in criminal justice from Boston University, Metropolitan College and a Doctoral Degree in Criminology from the University of Portsmouth, United Kingdom, Centre for Counter-Fraud Studies. She is a Certified Registered Pharmacy Technician in the State of Illinois (license # 049-123224) and a Licensed Private Detective in the State of Illinois (license # 115.002527) and the State of Washington (License # 21023320). Susan is a member of the Professional Council for Roosevelt University, School of Pharmacy. In 2012, Susan earned her Accredited Healthcare Fraud Investigator (AFHI) designation from the National Healthcare Anti-Fraud Association.