Articles by Evan Sweeney
Unnecessary ultrasounds on the rise for low-risk pregnancies
In 2014, pregnant women underwent fetal-ultrasound procedures an average of 5.2 times per delivery, a 92 percent increase over the previous decade, according to The Wall Street Journal.
Requiring Part D plan sponsors to report fraud activity would fix one of the program's many gaps
Watchdog agencies such as the Office of Inspector General have routinely identified ways in which the Centers for Medicare and Medicaid Services can prevent fraud, waste and abuse within the Part D program. Those recommendations were highlighted in last week's House Subcommitee hearing, and it became strikingly clear that voluntary reporting of fraud data by Part D plan sponsors is contributing to a massive lack in oversight. Until CMS requires--rather than encourages--plan sponsors to report the data, predictive analytics and fraud prevention efforts will never get off the ground.
Trinity HomeCare settlements offer a glimpse of future FCA litigation
The recent $2.5 million settlement between the New York State Attorney General and Trinity HomeCare highlight trends in False Claims Act enforcement.
Aetna fires agent who sold high-deductible policies to homeless
Amid an investigation by the North Carolina Department of Insurance, Aetna announced that it was severing ties with an insurance agent that admitted to selling high-deductible insurance plans to homeless in North and South Carolina by instructing them misreport their income.
Wisconsin state budget repeals Medicaid whistleblower law
A state budget passed last week by the Wisconsin Legislature included subtle language that will repeal the state's Medicaid whistleblower provision.
Fraud Prevention System yields nearly $3 for every dollar spent
A report released by the OIG Tuesday indicates that the Centers for Medicare & Medicaid's (CMS) Fraud Reporting System (FPS) resulted in more than $133 million in adjusted actual and projected savings within the Medicare program in 2014, translating to a $2.84 return on investment for every dollar spent on the program.
A healthcare fraud scheme that deserves a life sentence
On Friday, a U.S. District Judge sentenced former Detroit oncologist Farid Fata to 45 years in prison for a Medicare fraud scheme in which he grossly overprescribed chemotherapy treatments to patients that didn't actually have cancer or no longer needed treatments. For the victims and their families, the case concludes one of the more horrific and life-altering instances of fraud. In the aftermath, it's worth looking at why these kinds of horrific schemes occur and what can be done to prevent future cases from leaking through the system.
House subcommittee grills OIG, CMS on Part D fraud and abuse
Highlighting two recent reports by the Office of Inspector General (OIG) that reveal missed fraud prevention opportunities by the Centers for Medicare & Medicaid Services (CMS), members of the Subcommittee on Oversight and Investigations grilled leaders of the OIG and CMS at a hearing Tuesday, looking for ways to detect and prevent Part D fraud, waste and abuse.
Newly formed Super PAC defends Florida cardiologist facing federal fraud charges
One of the highest paid physicians in the country will get some financial support from a newly formed political action committee aimed at defending the Florida cardiologist from allegations that he billed for unnecessary services and provided kickbacks to patients.
With $202M on the line, FCA case could redefine hospice standards
A pending False Claims Act case could have broad implications for hospice providers across the country, potentially setting a new standard in determining when patients qualify for hospice services, according to AL.com.
