Nancy Kaplan Email & Phone Number

Indianapolis, Indiana, US

• Serves as compliance director for the Virginia, D.C. and Maryland Medicaid Health Plans.
• Collaborates with internal and external stakeholders to advocate and innovate strategic programming that corrects issues, remediates risk, and advances Anthem's Compliance Program.
• Creates and reviews policies, procedures and tools needed to operate daily function of program.
• Manages or lead advanced compliance monitoring.
• Advises, coaches and mentors executives and senior management regarding compliance issues and provides reports as appropriate to relevant committees.
• Leads compliance committee activities.

• Implemented a Medicaid compliance program for the Anthem HealthKeepers Plus product line, including Medallion and Commonwealth Coordinated Care Plus (CCC Plus), that served to prevent, detect, and correct compliance.
• Assessed compliance risks and issues, and developed work plans to address identified risks and issues.
• Develop a compliance work plan annually.
• Monitored health plan performance standards for compliance with contractual and regulatory requirements and maintained a general focus on call center metrics, claims payments, encounters, and vendor management.
• Ensured regular meetings of the health plan compliance committee to discuss identification and assessment of compliance initiatives, potential risks and issues, and the state of compliance at the health plan.
• Served as liaison to external and internal audits between business owners and state/federal entities and conducted internal audits of the health plan as needed.

• Researched and provided guidance to the Nevada health plan and corporate departments regarding compliance with the requirements of the Nevada managed care contract, the Nevada Medicaid Services Manuals, as well as.
• Served as the primary representative for the Nevada health plan and the corporate departments with state regulatory agencies.
• Negotiated with Nevada state agency regarding amendments to the Amerigroup managed care contract and draft proposed contractual language.
• Revised Nevada non-provider subcontractor addendum to be used to supplement corporate vendor contracts.
• Assessed proposed and final legislation with potential impacts on business activity and operations, discussed such legislation with the government relations team, and alerted the health plan and corporate departments.
• Reviewed all marketing materials, member and provider correspondence materials, and outreach materials for compliance with the Nevada managed care contract and applicable statutes and regulations.

• Worked with team of healthcare attorneys to prepare materials for a CDC Essential Services Grant for the allocation of scarce medical resources during a large scale pandemic or other disaster.  Drafted ethics chapter.
• Researched health facility licensure statutes and regulations pertaining to emergency preparedness and drafted a corresponding legal module; researched and prepared a presentation on the 2009 changes to the Stark law.
• Advised a client regarding pandemic planning issues under the Americans with Disabilities Act.
• Reviewed business related agreements.

• Assisted clients on issues relating to Medicare and Medicaid enrollment and reimbursement, HIPAA, Stark, the Federal Anti-Kickback statute, DEA and Board of Pharmacy issues, non-profit taxation and Virginia Department.
• Provided guidance on medical research ethics issues and served as a member of a hospital bioethics committee.
• Assisted clients in review and preparation of compliance plans and materials.
• Established corporations and limited liability companies and worked on corporate governance projects.
• Drafted and reviewed business related agreements.

• Served as Clerk to the Honorable Joseph A. Leafe and the Honorable John C. Morrison.
• Drafted judicial opinions and memoranda on a variety of civil and criminal issues, including the Virginia Freedom of Information Act, eminent domain, contract issues, and exceptions to the Report of the Commissioner in.

M.A., Masters In Bioethics

B.A.

J.D.