Medicare Fraud Patrol Recruits Seniors

CMS is tapping the shoulders of seniors, asking them to join the team. What team, exactly? The ever-expanding team of various government employees and volunteers coming together to fight Medicare fraud. CMS recently put money behind several Senior Medicare Patrol (SMP) programs and awarded various state SMPs with another $9 million to fight Medicare fraud. These awards are part of President Obama’s initiative to educate Medicare beneficiaries on how to protect themselves and Medicare from fraud. SMPs rely on approximately 5,000 volunteers nationwide to enhance their efforts.

The most recent award went to the Florida Senior Medicare Patrol, which received a $400,000 federal grant to help catch medical scammers, phony billers, rip-off artists and identity thieves in 2012. Three employees and three consultants have recruited an army of 400 volunteers that will use the funding to teach seniors how to avoid Medicare fraud and how to report suspicious bills.

 “If they somehow begin to look at their [billing] notices and see things, we have paid for the program,” said program manager Makeba Huntington-Symons. “If we can teach them to be on the lookout for fraud, that is half the battle.” The Florida SMP has a proven track record. From the group of volunteers, 456 suspicious situations were flagged, which produced 217 tips solid enough to report to Medicare fraud investigators.  According to a report, in 2009, a retiree noticed residents of an assisted living facility being bused every day, she said. It turned out they and the facility owners were being paid kickbacks to attend a mental health program that billed Medicare $3 million for phony treatments.  Medicare prosecuted and got back $1.3 million, Huntington-Symons said.

SMP volunteers educate Medicare beneficiaries, family members, and caregivers in their communities about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity.  Volunteers also encourage seniors to make inquiries to the SMP Program when such issues are identified, so that the project may ensure appropriate resolution or referral.

 “CMS is committed to working with partners like the Administration on Aging (AoA) to develop and implement long-term solutions and a collaborative approach to eliminating health care fraud and abuse,” said Peter Budetti, CMS deputy administrator and director of the Center for Program Integrity.  “We’ve dedicated $9 million in grants this year on top of another $9 million last year to expand the state-based Senior Medicare Patrol Programs, which are vital to empower seniors to identify and fight fraud.”

 “This demonstrates AoA’s and CMS’ shared commitment to educate beneficiaries so they can protect themselves and Medicare as a whole,” said Assistant Secretary for Aging Kathy Greenlee.  “I thank the Centers for Medicare & Medicaid Services for their continued partnership in this effort to educate seniors about health care fraud.”

 Maine is another recent recipient of these federal funds to help combat Medicare fraud. Maine’s SMP in the office of Elder Services will receive a $88,750 grant. Funds from this grant will be used to boost awareness among Medicare beneficiaries about how to avoid, identify and report instances of fraud.

 More than 4 million Medicare beneficiaries have been educated since the start of the program in 1997, through more than 1 million one-on-one counseling sessions with seniors or their caregivers. More than 25 million people have already participated in community outreach education events. According to CMS, in fiscal year 2010, more than $4 billion was returned to the Medicare Hospital Insurance Trust Fund, the U.S. Department of the Treasury, and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. A list of grants to states is available on the CMS website.