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About Susan
Sue Murphy provides comprehensive legal services to healthcare industry clients, focusing on healthcare regulatory matters, commercial transactions, mergers and acquisitions, joint ventures, fraud and abuse, and managed care. She has counseled clients on clinical integration and new delivery models such as ACOs; Medicare and Medicaid reimbursement and regulatory issues; HIPAA; federal and state fraud and abuse matters, licensure and certification requirements; and corporate compliance. Sue has advised hospitals, large medical groups, independent practice associations, practice management companies, research institutions, long-term care providers including skilled nursing facilities, continuing care retirement communities and home health agencies, HMOs, drug manufacturers, pharmacies and pharmacy benefit managers and employer self-insured plans.
Experience
Recent Notable Matters
National health insurer — divestiture of two HMOs in accordance with a Department of Justice mandate to enable the client’s acquisition of another insurer’s managed care products*
Independent practice associations and physician hospital organizations — formation of numerous entities, including instituting policies and procedures that included antitrust parameters vis-à-vis payors and negotiations of managed care contracts*
Independent practice association — formation of largest single-specialty entity in Houston from separate practices, including advice on antitrust issues*
Single-specialty independent practice association — successfully defended largest independent practice association in Houston in a Department of Justice inquiry into monopolization and potential price-fixing*
Healthcare providers — audits and reviews regarding compliance with referral laws and Medicare program billing requirements and developed compliance plans*
National hospital company — defense in one of the nation’s largest fraud investigations*
Physician practice management company — defense in two separate qui tam cases involving allegations of state and Medicare billing violations, fee-splitting, and illegal referrals *
* Work completed prior to Bracewell