Nancy Kaplan Email & Phone Number

Norfolk, Va, Us

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.• Manages or leads the most advanced investigations, document findings, complies with notification requirements, ensures corrective actions are made.• Hires, trains, coaches, counsels, and evaluates performance of direct reports on regulatory and compliance activities.• Develops an annual compliance work plan.• Monitors performance standards and marketing integrity 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 gaps and deficiencies, to promote compliance with corporate policies and to uphold an ethical culture.• 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.• Reviewed relevant policies and procedures that impact the health plan and provided assessments to critical stakeholders and senior leadership on consistency with regulatory and contractual requirements.• Reviewed all member and provider facing documents for compliance with contractual requirements.• Developed marketing integrity program and oversight plan for the health plan marketing activities and monitored marketing activities.• Developed and monitored corrective actions 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 state and federal statutes and regulations.• 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 about legislative impacts.• 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.• Reviewed new federal and state statutes and regulations.• Reviewed and revised health plan and corporate policies and procedures and drafted health plan policies as needed.• Reviewed and revised marketing materials to ensure statutory and regulatory compliance.• Responded to material requests and questions for audits; served as liaison and facilitate interactions with auditors.• Led interdisciplinary team to raise HEDIS behavioral health scores.• Served as interim plan compliance officer for the Nevada health plan starting in December 2012 with tasks including leading monthly compliance committee meetings, conducting health plan HIPAA audit, conducting audits of marketing representatives, ensuring that new hire compliance training is completed timely, assisting with compliance issues associated with employee terminations and assessing health plan risks.

• 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 of an implementation guide to be used in conjunction with a pandemic planning guide.  Prepared materials for a statewide hospital ethics meeting and for a statewide home health care and hospice conference call for pandemic preparedness and planning and prepared manuals and workbench materials for a medical tabletop exercise to test the effectiveness of pandemic planning. • 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 including the modified definition of DHS entity, the change in the per-click and percentage based compensation rules, and the impact of the Fraud Enforcement and Recovery Act on the False Claims Act; researched the anti-markup rule, billing reassignment rules, and Stark exceptions to advise a client on a business arrangement; and researched HIPAA and state health records privacy acts to advise a client on an employee records issue. • 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 of Taxation issues, and patient consent issues. • 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 Chancery.

M.A., Masters In Bioethics

B.A.

J.D.