Dr. Susan Hayes
Principal
Criminologist, Health Care Fraud Investigator
AHFI, CPhT, LPD (License Number 115.002527)
Phone: (847) 540-9590 ex 102
Email: Susan.Hayes@PIConsulting.org
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 patented products through the United States Patent Office. Susan specifically manages the large, complex projects that PIC is known for completing on budget and on time.
In coordination with the work at PIC, Susan is the Director of the Healthcare Ethics and Analytics (HEAL) Certificate Program for Roosevelt University, College of Science, Health and Pharmacy. In that role, Susan coordinates the administrative functions of the Certificate Program. Additionally, she provides instruction at the master’s degree level for students in both the Criminal Investigations/Health Law and the Capstone classes for the Certificate Program. During the Capstone phase of the Certificate Program, students research key areas of multi-disciplinary interests in social justice, health care and ethics using analytical tools, such as Excel, Python and Business Intelligence.
Lastly, Susan provides expert witness testimony in key pharmacy litigation issues and was the testifying expert in the landmark Rutledge v. PCMA case involving states’ rights to control inferior contracting practices in the pharmacy benefit management industry, rendering a unanimous 8-0 decision by the United States Supreme Court. 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 over 40 years’ experience in the health care consulting, pharmacy benefit management industry. 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 amounting to over $1 million annually in revenue. Clients included Fortune 500 employers.
Susan has a Bachelor of Science Degree in criminal justice from Northeastern Illinois University, a master’s degree in criminal justice from Boston University, Metropolitan College and a Doctoral Degree from the University of Portsmouth, United Kingdom. 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 Washington (license # 21023320). In 2012, Susan earned her Accredited Healthcare Fraud Investigator (AFHI) designation from the National Healthcare Anti-Fraud Association.