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John Marshall
Senior Director

Government Programs Compliance; Medicare, Audit, Investigations, & Process Improvement

John Marshall is a Senior Director at Ankura, based out of Phoenix but located in Louisville, who focuses on regulatory compliance and operations related to government-sponsored healthcare programs. John brings experience working with payers including Medicare Advantage and Part D, Medicaid, and Affordable Care Act and Tricare programs as well as a range of healthcare providers. He specializes in enterprise-wide collaboration and oversight programs, audits and investigations, strategy development for engagement between payers and provider groups, and process improvements.

  • Experience

    John joined Ankura in 2018 with the firm’s acquisition of the disputes, forensics & legal technology segment of Navigant. He previously spent nine years in-house with insurer Humana, where he honed his expertise in internal audits in a series of increasingly senior roles before focusing on management systems and risk mitigation. John began his career with PricewatershouseCoopers.

    Over the course of his career, John has helped multiple large national payers conduct investigations and improve their investigative processes in addition to conducting multiple Medicare independent audits. He has led internal teams that have supported inside and external counsel investigating such issues as Medicare risk adjustments, Medicare sales, accounts payable, claims processing, enrollment, pharmacy rebates, and identity theft. John has also conducted investigations into Part D coverage determinations and process for reviewing coverage requests.

    John has also managed multiple internal and external audit teams responsible for overseeing and monitoring numerous aspects of payer and healthcare delivery operations. He has worked with clients across the industry to map processes, assess effectiveness, identify opportunities for improvement, craft strategies, and implement changes.

    John’s professional experience includes:

    • Internal Auditing, Healthcare Insurer: Led the team responsible for the compliance and effectiveness review of internal and external investigations teams, efforts that included assessing the teams’ due diligence and ensuring that results were examined across investigations to look for connections.
    • Enterprise Investigations Initiative, Health Insurance Provider: Created and led a corporate consortium overseeing the coordination and improvement of investigative processes across more than a dozen independent investigative groups.
    • Process Improvement, Healthcare Insurer: Served as strategy leader and managed the development of prioritization, accountability, and transparency programs for all major market functions.
    • Population Health and Provider Management, Healthcare Insurer: Created a system focused on increasing provider and payer engagement.
    • Standards Assessment, Clinical Program: Consulted with a newly acquired Risk Bearing Organization (RBO) and developed a collaborative program to identify strategic, operations, and compliance standards for healthcare delivery. John then led the internal audit team in subsequent reviews of the new framework, identifying compliance gaps and developing corrective action plans.
    • Sanction Remediation Support, Medicare Payer: Led a comprehensive engagement involving Part C-organization and Part D -overage determination, appeals, and grievances, audits and monitoring, risk assessment and compliance structure, staffing, and investigations, among other areas.
    • Enterprise Risk Management, Multiple Clients: Facilitated programs across market operations, providers, and managed service organizations to identify and prioritize business risks and create plans for ongoing monitoring and mitigation efforts.
    • Enterprise Risk Management Implementation, Medicare Payer: Worked within the Archer software to help load and build out the ERM portfolio.

  • Insights & innovation