Corporate Integrity Agreement: Preferred Partner or Liability? (with Jillian Marcus)
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Most healthcare operators hear "Corporate Integrity Agreement" and picture a punishment. Jillian Marcus, Chief Compliance Officer at Envision Healthcare, found the opposite. In this episode of The Compliance Advantage, she joins Ross Ronan to explain how a Corporate Integrity Agreement (CIA) turned her organization into a trusted, preferred partner with the Office of Inspector General (OIG), and how that same trust carried into stronger relationships with the hospitals and health systems she serves.
Jillian started as a litigator, moved into healthcare law, and spent years as a general counsel before Ross introduced her to compliance. She shares why the government wants compliance to sit apart from legal, reporting straight to the CEO and the board, and how her CEO's "first team" idea reshaped the way she leads a large compliance team.
The conversation gets practical fast. Jillian breaks down how to make compliance approachable instead of rigid, why the right compliance officer is a hard hire to get wrong, and how the government's own audit priorities (UPIC, RAC, CMS, and the monthly OIG work plan) hand you a roadmap for where to look. She also makes the money case plainly. With the Department of Justice (DOJ) reporting $5.7 billion in recoveries for 2025, most of it healthcare False Claims Act cases, a small investment in the program now protects the profits you already earned.
A grounded look at compliance as a strategic advantage, not a cost center.
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Does a Corporate Integrity Agreement make you a problem in the government's eyes?
No. Handled well, it can turn you into a trusted, preferred partner with the OIG. The trust is built through open disclosure, fixing issues in good faith, and showing the work to your independent review organization.
Why does the government want compliance separate from legal?
The OIG sees it as best practice for the compliance officer to report to the CEO and the board, not to the general counsel. That independence lets compliance raise issues without a filter.
What is the "first team" idea in compliance leadership?
Your most important team is the executive team you sit on, not just the department you run. That mindset builds the trust and shared strategy that make compliance a real partner.
How do you change the perception that compliance is rigid?
Make it approachable. Put real faces and names on training, keep the door open for proactive questions, and show people compliance is there to protect the business, not police it.
How does compliance protect profits?
It guards the money you already earned the right way. With the DOJ reporting $5.7 billion in recoveries for 2025, mostly healthcare False Claims Act cases, a small investment now can prevent large penalties and treble damages later.
How do you decide what to audit first?
Follow the government's lead. UPIC, RAC, and CMS audits, plus the monthly OIG work plan, show you exactly where the government sees risk, which makes it easy to focus your audits and win board support.
Can a strong compliance program help win and keep business?
Yes. Hospitals and health systems increasingly lean on a partner with a mature program, sometimes relying on them to train clinicians, which deepens the relationship and helps retention.
What is the best advice for a leader who still sees compliance as a cost center?
Give compliance a seat at the strategy table and invest a little early. A small spend on the program, policies, and helpline is a minimal cost against the large risk of penalties and reputational harm later.
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Ross (00:00.32)
So Gillian, so it'll it'll look like we're closing. So just remember to hang out afterwards because it it needs a second to upload. So yep. Okay. Ready?
Jillian Marcus (00:02.382)
Okay.
Jillian Marcus (00:07.405)
I will.
Ross (00:14.644)
Welcome to the Compliance Advantage. Today we have a very special guest, at least special to me. Her name is Jillian Marcus. She is the Chief Compliance Officer for Envision Healthcare. Jillian, welcome to the show and thank you so much for joining us today.
Jillian Marcus (00:28.985)
Thank you so much for having me.
Ross (00:29.184)
So tell us a little bit about your background. I know a lot about it. We've known each other for I think it's almost about 10 years now, which is amazing. and you came up through healthcare law and you are a lawyer by trade. tell us a little bit about how you got into that position, got into healthcare, and ended up in the chief compliance officer role.
Jillian Marcus (00:50.903)
Yeah. So I started my career as a as a young lawyer litigating because of course that was what I was gonna do. I was gonna be a courtroom lawyer. I'd seen too many TV shows. and realized really quickly that I hated it. that I really didn't want to fight all the time. And and so it became clear to me that litigation was not the route that I needed to take. So
I pivoted from being sort of an attorney at a private law firm to going in-house and practicing in house, you know, on the more corporate transactional side, which was much more collaborative and suited my personality. And then ultimately the this the switch into healthcare law was sort of fortuitous. there was an opportunity that was there. I really didn't have much background or experience in it, but that was twenty four years ago.
Ross (01:44.605)
Yeah.
Jillian Marcus (01:45.082)
and it's crazy because that company has changed and morphed and evolved and bit you know, merged with other companies, but it's still basically that's where I came from. that was that was almost 25 years ago. And so that's how I ended up sort of in healthcare. And then after serving in a number of roles in the legal department, ultimately as general counsel of one of our one of our entities, you
actually introduced me to the world of compliance because we worked together. You were about to set off on your journey of healthcare consulting and asked me whether it was something that I'd be interested in sort of making that switch from the law into compliance. And frankly I wasn't really sure. And we had to talk a lot about it and what the difference in the roles was. and I decided to to take a shot at it. And really I credit you with so much because it has been
it's been more than I could have ever asked for. And I would never actually go back permanently to wearing the lawyer hat again. And that's how I ended up in healthcare compliance.
Ross (02:56.03)
You know, I I think your journey is a fascinating one, but also a very unique one. And I know you might not think that way, but but in the world of compliance, it really is because we see a lot of at least today, a lot of general counsels who kind of want to do both, right? They're just like, Hey, you know what, I can take on compliance. And, you know, I think I think generally speaking that
They do a pretty good job with compliance, they do an okay job with the compliance, a really good job at being a general counsel. And they just kind of tack that on as being, yeah, I'm the lawyer, so therefore I can do compliance. But you know, in the bigger organizations or organizations where there's a lot of accountability on the compliance and the legal side, you know, you took a full jump to to to being a general counsel where you're practicing while you're giving legal advice to I can't give legal advice, even though I am a lawyer, right? And I can do these things and I know the answer.
Jillian Marcus (03:41.091)
I did.
Jillian Marcus (03:47.555)
Right. That's great.
Ross (03:51.129)
And you really like it. And that's just really something that I you don't see too many general counsels just going, ooh, yeah, I'm moved from here to there. And I think that's just so admirable because I think you've you took the role and made it yours and made it kind of you know exponentially great big you know because of your experience. I think that's really impressive.
Jillian Marcus (03:52.281)
That's right.
Jillian Marcus (04:10.371)
Well, well, I I you know, I don't know how impressive it is. I do know that I'm super grateful for the opportunity. You sort of introduced me to it. So I would say that. and I'd also say that, you know, and we know this, a lot of this I learned from you many years ago, but really for larger organizations, it is the government likes to see a separate compliance function from a separate legal function. Now we know that's not always that's not always possible.
And we know that it's not necessarily a bad thing for the general counsel or CLO to hold the role of compliance officer as well. It's just sometimes the way the organization is structured, or again, if it's a small org, the way that it needs to be structured for, you know, for for fiscal reasons. But really, the government loves to see and believes it is best practice for the compliance officer not to be beholden to the general counsel or the lawyers.
but only you know, to the CEO and or the board of directors or both. in my case, I report directly to our CEO with a dotted line to the board. And that really is what, you know, the government likes to see. So it has been, you know, it it has been great taking my lawyer hat off. Every once in a while someone will ask me my opinion and I'll say, Well, I'm gonna put my lawyer hat on, but you can't rely on this as legal advice because, you know, we don't I I'm not able to give you privilege in this role anymore. But
But it's been it's been wonderful. Yeah.
Ross (05:34.259)
And we'll get into that a little bit because I think you have some firsthand experience with what the government likes to see. And we'll we'll dig into that here in a second. But so as you've kind of built your career as a compliance executive, because I do think that that you're you're much more than a compliance officer at some point in time, you do sit as an executive level, you do educate, you do do strategy, you talk to your CEO, you are kind of that right hand when it comes to what is there a risk or what is there a profile.
Tell me, as you're leading your very large team of compliance folks, book mentor, some sort of philosophy that you put into place to help you kind of lead and also become that compliance executive. Because I do think there's an extreme difference between a compliance officer and a senior executive.
Jillian Marcus (06:22.273)
Yeah, so there's so there's two things there. So I'd I'd answer the first part, which is sort of what philosophy or you know, sort sort of have I have I led by in my journey, you know, becoming a leader over the past number of years. And I would say it was something that an organization, a company that's now part of Envision did a lot of many years ago. And it was and it's it's many people have heard of it in business school, it's very common. It's called lean process improvement.
Some call it Six Sigma. There's a number of different, you know, different sort of process improvement philosophies out there. And the reason that I felt like it was very fundamental to how I've learned to lead is because it's based on collaboration. And you learn not only to look at processes critically and what are we doing now and how can we do it better, literally breaking down a process, but from a leadership perspective, it teaches you how to collaborate with everybody.
How you want to break down walls among different levels within the organization, within different types of roles and responsibilities and people to understand what is happening in the org. If you are only talking to vice presidents, if you are only talking to folks in your peers in the legal department or in the compliance department, you are not truly going to understand what is happening in the organization and how to talk to and approach.
And educate and learn from those individuals. And the lean process improvement sort of model is you get into a room to fix a problem with a whole bunch of different employees at a bunch of different levels. And so I could be in a group with a billing clerk and with, you know, with a teammate relations person from HR and someone in the IT company and also a senior vice president. And so
I think that gives you a different perspective on how on on per on on others' perspective. It gives you a it it gives you an idea of what morale may look like in the company. It gives you a perspective about how to listen better, right? Which is to me a key of leadership. It's not talking so much. If I'm talking too much in a meeting, it means I'm doing something wrong. and those skills I learned through that process, those leadership skills.
Ross (08:43.806)
You know, it's it's it's really important to talk about learning and learning from other people within an organization because I think that is the number one thing that sometimes compliance gets wrong, which is you know, we don't compliance back and forwards. We may not know the business, we may not know our counterparts, we may not know the people that we're supposed to support. And I think with these lean processes or the Six Sigma pieces of it, it really does
Jillian Marcus (08:58.329)
Mm-hmm.
Ross (09:13.802)
kind of remind you that in order for compliance to be successful and to be that strategic partner, a you got to understand the business. You got to know what you're talking about. You have to have lived it a little bit or at least talk to operations. And then two, talk to everybody that you possibly can to understand how compliance affects their job on a daily basis, big C versus little C, right? Big C compliance is the departments that we run.
Jillian Marcus (09:27.917)
Yes. That's right.
Ross (09:40.81)
Little C compliance is the compliance that we do on a daily basis with everything that's around us. So so I think that's really important to think through.
Jillian Marcus (09:45.082)
Right. That's right. That's right. And and being an operational lawyer where I came from really helped because you are deep in the business and you, you know, working your, you know, working my way up through the sort of the ranks of the legal department, you learn how the business works, what the, you know, what the strategies of the business are, and that can only help you. and you'd asked me a question about sort of, you know, that strategic relationship with executives and what that looks like. And
In my in my current role with our current CEO, I'm really lucky. He has this concept called being on a first team. And when you think about when you're executive, when you're an executive, you typically think about it's a group of executives and you're each over your own team. You could be an executive over HR, over finance, over IT, over compliance. But when you sit on an executive team,
Ross (10:24.02)
Mm.
Jillian Marcus (10:41.729)
Your first team, really, your most important team is that executive team. So it's a different way of looking at that from a leadership perspective. My first team are the executives, you know, are those heads of departments, and we are a team. And that actually, in some ways, comes before being the chief compliance officer or the head of compliance. And it's that way in which you build those relationships, you understand what each other, you know, are doing and what's happening strategically at.
Ross (10:46.165)
Mm-hmm.
Jillian Marcus (11:11.457)
in the organization. And it's that way that you build the trust, which is, you know, as you know, sort of critical to work really well as a group. And that's also in that role, I'm not just giving compliance advice, right? Strategy. We're talking you know, financials. We're doing all of those things that you do as an executive, not just the head of the compliance department.
Ross (11:37.077)
I love that thing. I love that thinking because we talk about it all the time. And a lot of compliance people just like, here's my fiefdom, right? And that's my department. And that's where I need to stay. And that's where I need to function. And there's a lot of people who feel that way, whether it's HR operations or whatever. And in this model that you're talking about, which is kind of my philosophy overall, I've never heard it put it into this as my first team, which is, you know, your primary goal is to support.
Jillian Marcus (11:45.143)
Yes.
Ross (12:05.416)
your teammates, which is your entire executive team right across the Borkabus and be a strategic partner. That's a really that's a really great way of thinking about it. And all the CEOs and the board members and the compliance officers who are listening to the podcast take note of that because I think that's really an important kind of discussion to have. And I really feel like it builds you know, you hate to talk I I hate to talk about it. You might like to talk about it, but this
Jillian Marcus (12:11.033)
That's right. That's right.
Ross (12:33.696)
culture of compliance and I hate those words because I think they've been so bastardized over years and overused and they've kind of lost their appeal. This is what we're talking about here is building that culture across the the book of business. So that's amazing.
Jillian Marcus (12:39.449)
Over overused and yes.
Jillian Marcus (12:46.425)
That's right.
That's right. That's right. I love I love that concept. It's it has been sort of new for me as well to think in those terms, but it makes a tremendous amount of sense.
Ross (12:56.16)
Now, when you talk about all these executives on your first team, I love that conversation. We're gonna kind of go with that right now. And so thank you to your CEO. I don't know him, but I appreciate the fact that that's out there. what are kind of the misconceptions you hear from some of these executives that you're working with and for, whether it's the CEO, COO, board, or just your colleagues across the board? What's kind of misconceptions that they have?
Jillian Marcus (13:01.913)
Yep. Yeah.
Jillian Marcus (13:20.249)
Yeah. Yeah.
I think that misconceptions in general, not so much, not so much the executives on my team, but this is sort of a sort of I think a common issue with compliance, is that we are compliance people in general, and I'm sure you've heard this, Ross, are being are seen as inflexible or rigid. And the problem with that, right? So that is, I think, a common misperception that may or may not, depending on who you're working with, need to be fixed.
Right. And so the challenge often for being a compliance officer is to say, we're actually not those things at all. We're not rigid. We're not flexible. We're actually your partner. Right. We talked about that. Right. We're on the same team. We can actually help you, you know, you know, retain profits. We can do all of these things that are very proactive, they're very smart for the business. And you should come to us.
Proactively. You should come to us before something's a problem. and being very approachable and open and sort of not scary and not intimidating, those are really kind of the winning solutions to make anybody that has doubts about compliance come over to your side. We've spent a lot of time in our organization working to make compliance accessible.
Ross (14:50.612)
Mm-hmm.
Jillian Marcus (14:51.225)
And I know that sounds that may sound odd, but to make it really accessible and easy to reach out to. Things like as simple as putting our pictures in our training materials, to say, hey, these are real people and here's their number, and they're telling me to call them no matter what, and it's gonna be okay, and we're gonna help them solve whatever their issue is. So things that can make it accessible at our annual conferences.
on the main stage, we'll do something really fun, like play game show about compliance. And I will tell you, historically it's been one of the the the the the sessions that gets the most positive feedback because it's really fun. All of our clinicians are engaged. We give out prizes. It's just it's great. And it also goes toward we are not a scary and flexible team. We're fun.
We want to educate you on the things that actually matter in this industry. It's not an off-the-shelf type of compliance department. and so all of those things help if there is a conception about what compliance is to hopefully change that. And I think we've done a pretty good job at the company doing that.
Ross (16:02.784)
You know, I think compliance officers have actually built this as a self-fulfilling prophecy, right? you know, the government came out and said, hey, you guys all need compliance officers at your location. And what do healthcare companies not want to be told to do? Anything by the federal government of what they have to do. Now they have to put someone who's an officer, who's not an officer of the company, who's not a police officer, who's not anybody else in the company that has an officer title to it.
Jillian Marcus (16:15.97)
Mm-hmm.
Jillian Marcus (16:27.043)
That's right.
Ross (16:31.37)
To be responsible. And we, you know, we not me, but we in compliance took that as being we're a hammer looking for a nail, and therefore we're gonna go out there and do that. And I think the new generation of compliance f individuals, and again, someone called me a Gen 1 compliance officer, and I really got upset by that because I didn't want to be that old, but it's true, right? And and you know, we delert develop right, and we developed this over the years. but you really do have to learn how to be
Jillian Marcus (16:51.011)
Ha ha.
Or the same age, so it's okay.
Ross (17:00.636)
not like in not not be flexible, put the guardrails, understand how you're getting from point A to point B and being approachable. And I think this is really important when you know the listeners who are talking about this, who are healthcare executives, when you're hiring a compliance officer, I mean, you know, our process at hiring at Ronan is extremely rigorous because we have this process of saying, you're going to go through all these zoops, we're going understand how you think, we're going to understand how you deal with situations, we're going to understand how you talk
Two CEOs. And one of the biggest things that you that that's a hard bell to unring is putting in a compliance officer who may not have the right fit, who then you have to let go. And the first thing that people say is, What? You got a problem, you're getting rid of the person who knows all the information and we're gonna hang them after you, right?
Jillian Marcus (17:53.325)
That's not whether would you never want to be there? Yes.
Ross (17:55.84)
I
Devin Dalton (17:56.79)
Okay, one sec one second. Ross, it seems like your audio is behind on my side. You are you getting that, Jillian? Okay. I don't know if it's my Wi-Fi or or if that was actually happening, so I just wanted to that. But you're it's looking good. It's looking good on your side, Jillian, when he's talking.
Jillian Marcus (18:05.465)
I am not.
Jillian Marcus (18:12.121)
Okay. Okay. I'm not getting that. Yeah.
Yeah, I mean I again, he's super blurry, he comes in and out, but I don't have any problem with audio.
Devin Dalton (18:22.869)
Okay. see. Okay, Ross, can you say something?
Jillian Marcus (18:25.517)
Yeah.
Ross (18:29.056)
Check, check, check, check. Siblance, siblance, one, two, three, check.
Devin Dalton (18:33.387)
Yeah, it's like your your video is really delayed after you're talking.
Ross (18:39.912)
Let me stop my video.
Jillian Marcus (18:40.569)
I wonder if it's Ross's wifi, which is which is why he's blurry. That's only the same.
Devin Dalton (18:44.523)
Yeah. The it's not blurry on my side, it was just the it's not matching to the
Jillian Marcus (18:49.665)
Yeah, I'm gonna take a picture on video. No.
Ross (18:51.818)
How's that? Is that better? Devin? No. I'm still I'm still blurry to you and I'm still
Devin Dalton (18:54.517)
No. No.
Jillian Marcus (19:00.323)
Yeah.
Devin Dalton (19:00.853)
It's good now. It's working out. Yeah.
Ross (19:01.194)
Not it's good now.
Okay, I stopped and started my video again.
Jillian Marcus (19:08.825)
Okay. I just sent you a screenshot. Not that it matters. It's like your face is just like blurred. But you an email a text for us. Anyway. But you sound fine to me. Sounds fine.
Ross (19:19.306)
Devin, what do you so I mean, worst case scenario, Devin, is the video's not good, but the audio is good. So you know what I mean? We can use clips from videos that's good versus anything else. And they can probably try to match up because with Riverside they actually have separate audio and video, so we can probably match it if need.
Devin Dalton (19:25.451)
Okay, okay. Yeah.
Jillian Marcus (19:36.247)
Mm. Okay. That's fine. Yep.
Devin Dalton (19:36.907)
No. Okay, it's looking good now. I just wanted to flag it, so
Ross (19:40.69)
Okay. It's a good time to break, by the way. So
Devin Dalton (19:42.497)
Okay, go ahead.
Okay. Sorry to mess up your train of thought. Okay, go ahead.
Jillian Marcus (19:48.653)
Yeah, that's good.
Ross (19:49.963)
No, you didn't because I have notes. yeah, I'm really blurry on my screen, aren't I? Okay. hopefully it doesn't come out that way because I look very clean to me. So all right, ready? So let's let's switch kind of gears a little bit because we talked a you you talked about it. we talk about the compliance advantage that this is what this whole podcast is about, right? And there's a lot of different things that we talk about, whether it's you know, patient trust equity.
Jillian Marcus (19:53.55)
Yeah.
You know what I mean?
Ross (20:19.73)
or profit protection, which you men mentioned, but also this idea that we've come up with that it's really kind of the preferred partner status. And what I really want to talk to you a little bit about, and I know that Envision was under a corporate integrity agreement. And you know, this may have been your kind of your first corporate integrity agreement to be adequate, you know, involved in or manage or run or even kind of get to the point where you've you know help settle it in that standpoint.
Walk us through kind of the relationship you had with EOIG and your IRO, where you've you kind of become less of this person or this this entity that is a problem, right? Because everybody thinks if you have a CIA or have some sort of monitor, that you're a problem child. And, you know, again, I managed about nine corporate integrity agreements over my tenure, and I have a direct opposite.
response to that is you kind of become this preferred partner to the OIG and they're like, hey, we trust you. So tell us a little bit about the advantages that you had versus just the obligations of reporting.
Jillian Marcus (21:29.389)
Yeah, I mean, it sounds like my experience managing the CIA was similar to yours. This this it sounds crazy to say this, but the experience managing the CIA and the was so positive. And I mean, you never want to be under a corporate integrity agreement, of course, and you do everything you can to make sure you're doing the right things, and that never happens, but in the event that it does.
It was an incredibly positive experience. So we had a wonderful relationship with our OIG monitor. We actually had a change in monitors after a few years. So we had two different monitors, always very professional, very collaborative. we were, you know, as as responsive as as possible, and as you know, as prompt as possible. Our relationship with our IRO, our independent review organization.
which in our case was a law firm, not an accounting firm, was incredibly strong. And we built so much trust, I believe, with our IRO over the years that we would have open conversations about, you know, if we found an issue and what's the best way to talk about this issue and disclose it. Or do you think it's an issue? Is this something that we need to go and and talk more about? And that trust that we built, now, you know, it's interesting because
there was a relation there was there was a trust relationship ultimately the IRO is an agent sort of of the government, right? So it's not, you know, they're not your friend, but you can still build, yeah, right. But you can still build a very professional and collaborative relationship with an IRO. And they will see, because we would go to them openly and say, we found this. Do you think this is a problem or not? Let's talk about it. And I think that did build trust. And so they did see us as
Ross (23:04.774)
All right.
Jillian Marcus (23:27.545)
I I I believe the exact type of organization that they would hope to be able to work with under a CIA. and I know again that sounds crazy, but it was just a very, very positive experience. It was a tremendous amount of work. Again, you never want to be there. But if you're going to be there, the best way to manage it is to be collaborative and as open as you can be.
with both the OIG and the IRO and it just makes the process go very smoothly.
Ross (24:01.024)
You I had the same relationship when I was managing our kind of CIAs at the time. And it almost became like a breath of fresh air when you brought something to them, or you had a disclosure, or you had like an overpayment, or you had another issue outside of the CIA that came to them. I you know, generally the response that I got from them was, Well, well, thank God it was you guys versus somebody else, because
I know that you're gonna take care of it because of these things. And yeah, it happened over the past. And we always say things are going to happen. It's not, you're not preventing everything from happening. It's how you deal with it, right? That you can actually that's your benefit. So, you know, we I saw that too. And and I really do think that people don't understand that people, healthcare executive people in the healthcare industry of saying that preferred partner status with the government.
Jillian Marcus (24:37.805)
Yeah.
Ross (25:00.296)
is really, really I always talked about it going, how can we get our compliance program certified by the OIG? And they're like, We're never doing that. We're never doing that. I'm like, You sure? You sure you don't want to have that? but that would be amazing to
Jillian Marcus (25:09.657)
Yeah. Right. Right.
And and I and I agree with that. And I do think that you build you build the trust with the IRO. You show that year over year when they're doing their, you know, transaction review audits, that you are correcting anything that could be an issue, right? 'Cause they're always going to you're always going to have stuff and find things. Issue is to your point, what do you do about it? Right. Are you acting in good faith to fix them?
Ross (25:31.743)
Well.
Jillian Marcus (25:38.89)
And we would, you know, we would say, okay, we hear you on this and we're gonna go back and we're gonna do this and we're gonna change this process and we're gonna change this bonus arrangement or what have you. And then we would. And then we would demonstrate that we did it. And then they're very comfortable going back to the OIG and saying, they've got this, right? They've they they're making these changes and they're doing the right thing. And so I agree with you on that sort of the partner aspect of it, which again, it's not something you would think of.
And then, of course, another benefit that comes out of that CIA is that you have created this even more robust compliance program, right? I mean, Ross, you left me with a very mature program. And we were able to, during the five years of the CIA after you left, be able to build it even better. And we learned that we did that because we had to bring in outside consultants as part of our effectiveness review under the CIA, which is
part of any CIA generally. And we would receive that feedback that your program is very mature and you don't have a whole lot of required things to do differently, but here's some suggestions to make it even better. It's a great place to be, to have a program that people are looking at and that, and that just keeps getting better and better.
Ross (26:46.943)
Right.
Ross (26:56.99)
Now taking that preferred partner status and moving it a little bit more towards, let's just say business, right? So preferred partners with like say hospital systems. You guys are primarily hospital-based provider groups that are staffing hospitals, right? And then you know, dealing with payers and getting good compens, you know, getting good reimbursement and rates and things like that. Have you seen where compliance has played an advantage in some of those relationships as a preferred partner too?
Jillian Marcus (27:04.983)
Affair.
Jillian Marcus (27:27.779)
So what I have seen, we don't we're not always asked, you know, as part of, you know, an RFP process right at the very beginning, you know, tell us all about your compliance program. You know, if you're just like starting up at a, you know, at a hospital site organically. But the partnership that we may have with either the privacy official or the compliance officer at hospitals and health systems can become very important. So we have there's there have been many times.
Ross (27:36.02)
Mm-hmm.
Ross (27:53.108)
Mm-hmm.
Jillian Marcus (27:56.504)
Where they know that they have someone that they can really talk to in the legal and compliance department if they see anything. and and we are as collaborative as we pop as we possibly can be, you know, in those instances because they are our partners, they're our clients, and we want to be able to work together. We've also seen, w when you think about like preferred partnership, as you call it, we've also seen where hospitals have said, we think that you all
really are the ones that should be doing compliance training for our clinicians. Right. So it allows in some instances, we are training, even though they're on their medical staff, right? There are some instances where they've said we don't need to give, you know, the providers all this compliance training on the hospital side because we know you're doing it. We know you're doing a great job. And that could be Mtala, it could be regular compliance, you know, compliance education and training on areas of focus, on
Ross (28:28.202)
hmm.
Jillian Marcus (28:54.509)
You know, whatever that may be. But that's another way that we've sort of been able to partner with hospitals from time to time to extend our education and training to all of those clinicians. And that's something that makes them as okay in the hospital systems more comfortable.
Ross (29:10.334)
Yeah, it's it's really a great concept to think not only from a business development standpoint, which in your in your experience, you know, doesn't really play too much of a part, but kind of partnership retention or client retention going forward. And then also taking a lot of burden off of their plate to say, Hey, you don't need to do all these things. We got this, and we'll report to you. We'll give you that information. And that's a huge kind of client retention benefit back.
Jillian Marcus (29:24.408)
Right.
Jillian Marcus (29:31.229)
Jillian Marcus (29:36.217)
Right. That's right.
Ross (29:39.476)
to those different partners that you have.
Jillian Marcus (29:42.519)
Right. That's right. And that eliminates, you know, additional infrastructure and things like that that they may need to have because we have it, because we have such a robust program that we're able to do some of that. And we have had a few arrangements in the past with hospital systems where we have done just that. Yeah.
Ross (29:57.993)
Yeah, it's a it's an amazing concept. So hopefully people hear that from somebody who's actually, you know, contracting with these hospitals across the country. And I think that's really important to think about. now let's shift it a little bit to profit protection because I think that's really important. And I know in compliance we often shy away from this idea that we're we're deal with anything, you know, with profits, right? We don't want to talk about that. We don't want to we don't generate revenue, we don't do all those things. but we've kind of taken the
The stance that, you know, if you've lawfully earned those dollars and you've done them correctly and you should, you should keep that money, right? And therefore you should put the program in place to protect those profits that you've already earned. how do you make that case to your to your leadership? How do you explain how this protects those profits from that standpoint by having an effective compliance process?
Jillian Marcus (30:52.515)
Yeah, well, it's it's really easy. So the latest statistic is that the Department of Justice published that it has received $5.7 billion in recoveries for the 2025 calendar year. So when you look at those numbers, 5.7 billion, the majority of that is healthcare recoveries under the False Claims Act.
So the conversation becomes easy, becomes a lot easier. everybody knows, and if they don't, you know, they should, that healthcare and finance, those two areas, you know, those two sectors are the two most highly regulated industries that there are. And so if you are in the healthcare space, you must be aware that it is highly regulated, that there's all kinds of penalties that are associated with.
business activities that in other spaces are just good business. It might just be great marketing in some businesses, but in our business it's illegal and a violation of federal law and potentially criminal. And so when you when you educate a little bit about that, you know, and I'm lucky I have, you know, my executive team, you know, most of them have been in healthcare for many years. And our board has been, you know, we have a lot of seasoned healthcare professionals. But
Ross (32:01.884)
Yeah.
Jillian Marcus (32:21.365)
There have been times where, you know, I have worked with somebody that isn't doesn't come from healthcare. And those are the kinds of conversations that you have, right? And reputational harm is a real thing, right? And so if, you know, reputational harm, we know that when there's when there's CIAs, when there's other issues, when there's settlements, when there's investigations, the government often publishes those on their website.
And so their reput what you could be a privacy breach, which is, you know, yeah, slightly different than, you know, than a than a kickback issue or false claims act recovery, but they are still publicized by the government. And they're picked up by all the journals, right? And you don't want to read about yourself. You don't, you know, you don't want any executives to read about the company in Becker's or in any of the other journals. And so I think that conversation actually has gotten easier and easier.
for executives in healthcare to understand that compliance is here because there is such real risk, criminal, civil liability, and it has just it's become a lot easier because of the size of the recoveries.
Ross (33:31.733)
I'm glad you brought up the reputational harm because I do think that plays a lot into this preferred partner status, too. Because nobody but nobody wants to partner with someone who's a headline, right? Especially if it's a negative headline. And what is the first thing the DOJ and the OIG do when they settle a case is they do a news release and they want to put it out there and they tell how much money that they've come after. And they should. I guess they, you know, that's part of their process. But again,
Jillian Marcus (33:45.241)
That's right.
Jillian Marcus (33:53.945)
They do.
Ross (34:01.3)
You don't want to be deadline. And that's a number one thing for people stopping working with you and and saying you're you're bad people, right? 'Cause I mean, who who wants to have their name attached to Enron? Ever, ever, ever, right? You just don't.
Jillian Marcus (34:08.665)
Yeah.
Jillian Marcus (34:18.637)
That's right. And you know, and to your point, things will happen. And there are some times that that you know, things will just happen and it's unfortunate. But to the extent that you can be out in front of it and proactive and make sure that those things don't occur, that you're auditing and monitoring, that you're training your your workforce, that you're doing, you know, you have a robust program where people can come to you and
and tell you what their concerns are so you can get in front of it and fix them. All of those things are super, super important. So you don't end up as a headline. and that's always a real concern in healthcare.
Ross (34:56.572)
Always every day. Now kind of as we get to the end of this, what's your best advice that you would give to leadership, whether it's a CEO or a board who's still looking at compliance as you know, a cost center, right? You're just something that I have to have. Someone told me that that I need it. And by the way, you just sit over in the corner and then I'll call you when I need you, and then you can show up and then we can do stuff and go back in the corner. Like what what do you tell those those individuals who
And you probably don't have that right now, but I'm sure that there's come across some people not in healthcare who don't really understand it.
Jillian Marcus (35:24.974)
Yeah.
Jillian Marcus (35:30.169)
Sure, sure. And and and I don't have that right now, but I do think that, you know, the role of the compliance person has is becoming more and more important. And I think that's becoming more recognized as a senior leader. It isn't my company. I I see it sort of happening across the industry more and more. But I would basically say we should be at the table. You know, I'm fortunate that I am. I have my the first team, I'm on the first team, right? That I that
I described, keep us in the all the conversations about strategy, because there may be potholes, there may be things hiding that you just don't see that only somebody with a the compliance lens can see, whether it's, you know, the way something is is coded or billed or or there, you know, could be many things, the way things are presented on a dashboard, right? Red, yellow, greens, things that you need to look for with a different lens. So I would say number one.
make sure that you're at the table, make sure compliance is at table. And I would say, of course, you've got to have that right partner. It has to be the right type of approachable business person. So they're comfortable talking openly, right? With you. So you can all get to the right place. And then I would say the second thing I would probably say advice I would give is better to spend a little bit of money now on standing up a program, right? Getting your program in place the right way.
To avoid spending a lot of money later. Because a little bit of money now in your infrastructure, right? And getting your program in place, your policies in place, your helpline in place, like all of that are very, very minimal investments that could have a huge sort of return later. if you are not, you know, if you if you are ending up with a huge penalty and treble damages and
reputational, you know, harm, you know, when you're in the headlines and and all of that. And so spend a little bit now to avoid having to spend a lot later would be my second piece of advice.
Ross (37:35.359)
And how do you look at that when you have you know spending and being you know ready for things that are happening? How do you have that conversation about being proactive versus reactive? Because sometimes you get executive boards or CEOs who are like, we don't need to be picking up rocks, we don't need to be creating issues that are not necessarily there. We've heard that kind of I've heard that statement a lot. And I'm like, we're not creating issues, we're just
Jillian Marcus (38:01.975)
Yeah. Mm.
Ross (38:04.18)
looking in the shadows to make sure that there's not a boogeyman there in case someone else comes out and looks in the shadows. I think that's the same kind of conversation. How do you have that conversation too?
Jillian Marcus (38:08.941)
Yeah. Yeah.
Jillian Marcus (38:16.673)
Yeah, I think I again I think it's a matter of educating whether it's an executive or board member, you know, that to your point, about what the government is looking at. We always say there's a lot of ways, right, that we can know what the government is looking at. We have there's all kinds of audits out there, you know, your UPIC audits and your RAC audits and your CMS audits. And there's OIG work plans, you know, that they're updating on a monthly basis, the OIG.
What is it that the government is looking at? That's where they see risk. Or so, so whatever those things are, we need to look at those. Right. It's almost like they're telling us, hey, these are your risk areas, right? So it's a risk area for the government, it's a risk area for us. That's the easiest way to do it. Right. And it is it is very easy to to get support from your executive team or your board.
If you are showing them where the risk is, because the government's looking at it, right? And we did that. We said, we're doing audits, you know, how else can we find things? And we said, we're gonna do a focused audit on these four things. And the board said, why? And we're gonna say, because let's show you why, right? The board is looking at these four things or the government's looking at those things. So I think that the conversation.
about a little bit of investment holds here, right? Which is we're gonna look at we're not just randomly turning over rocks. We're looking at our business, we're seeing where the risk is, and we're focusing on that. Right. We know that there's risk there. And I think I've had a lot of success doing that.
Ross (39:57.568)
I mean the government gives you a roadmap, so why would you not look at it, right?
Jillian Marcus (40:00.888)
No. Absolutely. Absolutely. Pay attention to what they're telling you with some simple things, you know. So
Ross (40:09.03)
Absolutely. Well, Jillian, we're gonna wrap up one last question. Really appreciate your time today. I always think health is wealth and you're in healthcare. You gotta be healthy, you gotta be taking care of yourself physically, spiritually, and mentally. What do you do to to prepare for that? When you do take care of yourself, compliance is a very stressful place to be, so
Jillian Marcus (40:25.241)
Yeah, it is. You know, and so whether it was, you know, when I was wearing my lawyer hat or now I'm in my my compliance hat, I think setting setting some some the laptop time, right, where the laptop has to be shut down at a certain time, maybe you you know can come back and check a couple of times later in the evening. But I I feel like a lot of us have been trained to work all the time, right? And
Most of us are because, you know, on the executive team have to be kind of available twenty-four seven. but to have some parameters around that. For me, having dinner with my kids has been a priority for me. And so no matter what time it is, it could be 9 30 at night, but we're sitting down together. they're headed off to college. So that's gonna be that'll be a new sort of phase in my life. But but that's been a real priority for me. Spending time with close girlfriends is super, like super cathartic and
helps my soul and and yeah, and just trying to stay just trying to stay as active as possible because as you know, in our roles, you do spend a lot of time in a chair in front of the computer. So yeah, we're not we're not quite as physically active as some other some other professions. So just making sure you're getting out of the chair and getting some sunshine is really important for me.
Ross (41:23.367)
Mm.
Ross (41:44.106)
Good all good things, all good information and good ways of taking care of yourself. So Gillian, thank you so much for joining us today. It's always a pleasure to talk to you. we don't talk enough, so we need to we do need to talk some more, but thank you for coming on today and your insights were seriously valuable for everybody's listening. So thank you so much.
Jillian Marcus (41:56.663)
We
Jillian Marcus (42:03.767)
And thank you so much for having me.
-
Jillian Marcus is the Chief Compliance Officer at Envision Healthcare. She started as a litigator, moved into healthcare law, and spent years as a general counsel before stepping into compliance leadership, where she now runs a large compliance team.
Connect with Jillian on LinkedIn: https://www.linkedin.com/in/jillian-marcus-07200a6/
““The government gives you a roadmap, so why would you not look at it?” ”
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