For over ten years, Mr. Kaplan has been providing advisory services to health care industry entities.  He routinely leads teams in compliance program development, evaluation, implementation, and training. He is one of the foremost experts on Medicare/Medicaid regulation and compliance. He is called upon to work with executive leadership in various organizations to analyze and engage in strategic planning for compliance with Medicare and Medicaid requirements.

Mr. Kaplan led in the development of a Medicare claims review protocol and assisted clients in assessing the adequacy of their Medicare claims review processes.  He also developed methodologies for establishing fair market value compensation for physicians and allied health professionals working as consultants for pharmaceutical manufacturers, using government approved survey data. He is an expert in issues related to the Health Insurance Portability and Accountability Act (HIPAA), Stark laws, and the Balanced Budget Act. His clients include hospitals, hospital systems, pharmaceutical manufacturers, managed care organizations, government agencies, universities and academic medical centers.

PREVIOUS WORK
Mr. Kaplan has over 25 years of experience in the field operations of Medicare and Medicaid programs of the federal government. He served as the Regional Administrator for the Health Care Financing Administration (HCFA) in New England, now known as the Centers for Medicare and Medicaid Services or CMS.  He managed Medicare contractor budgets, state Medicaid Grants, state health department budgets and peer review organization programs for the six New England states.  He directed a varied health professional staff of physicians, nurses, nutritionists, and laboratory technologists, as well as accountants, systems specialists and policy analysts.  In his last two years, he served as Administrator of the Northeastern Consortium.  In that capacity, he managed the operations of the Boston, New York, and Philadelphia Regional Offices which had field jurisdiction over HCFA’s programs in 13 states, Washington, D.C., Puerto Rico, and the Virgin Islands.  He managed a staff of 415 people in these 3 regional offices and provided direction and oversight to 21 Medicare contractors, 15 Peer Review Organizations, 13 state health departments, and 13 state Medicaid agencies.  His responsibilities as Consortium Administrator included direction of the provision of Medicare and Medicaid benefits to over 19 million beneficiaries.

As a senior executive in HCFA, Mr. Kaplan participated in the development of HCFA’s first strategic plan. Mr. Kaplan directed a number of creative projects that had national implications for Medicare and Medicaid beneficiaries.  These included a 13 state study on the widespread misuse of drugs, the development of a national surveillance system for HCFA which develops population based information on the quality of care from HCFA’s data files, and a national project to identify best practices in health care purchasing in private industry.

EDUCATION/AFFILIATIONS/RECOGNITION
Bachelor of Arts, Government, Tufts University
Recipient, US Department of Health and Human Service’s Executive Management Citation Award
Twice recipient of the HCFA Administrator’s Citation 

PUBLICATIONS/PRESENTATIONS