Susan Hayes

About Me

Dr. Hayes is an Assistant Professional Practice Professor and the Director of the Health Informatics Master's Degree program as well as the Healthcare Ethics and Analytics (HEAL) Certificate Program for Counter Fraud professionals for Roosevelt University, College of Science, Health and Pharmacy.  In that role, Dr. Hayes develops curriculum, works with adjunct and other professors in the Health Informatics department, mentors students and performs research. The focus of her academic work is the multi-disciplinary intersection of social justice issues involving health care and healthcare theory, computer science and computer science disciplines.  Her research involves using Manual Pattern Recognition and Artificial Intelligence (unsupervised and supervised machine learning) to detect fraud, waste and abuse in healthcare claims.

Prior to her academic work, Dr. Hayes has over 40 years’ experience in the health care consulting and pharmacy benefit management industry.  Dr. Hayes has developed a specific expertise in applied criminological theory applications to fraud and investigation techniques.  She is the architect  of the COPs and CARs systems which are used by large managed care  organizations to detect, investigate and resolve pharmacy fraud and uses key white-collar theory as a basis for healthcare fraud detection.

Dr. Hayes 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.  Dr. Hayes is a strong advocate for community pharmacists and transparency in healthcare.  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.

Dr. Hayes' research interests are the application of criminological theory, the role of women in white-collar crimes and pharmacoethical and pharmacomoral decision-making and its implication to quality health care delivery.  Dr. Hayes is a Licensed Private Detective in the states of Illinois and Washington, an Accredited Healthcare Fraud Investigator through the National Health Care Anti-Fraud Association and is a Certified Pharmacy Technician licensed in Illinois.