Home Health & Hospice Week

Senior Medicare Patrol recovered $9.1 million last year.

Various types of government agents evaluate Medicare fraud, including attorneys, federal employees and audit contractors. However, not every person checking for fraud is a government entity — in fact, some of them might be your very own Medicare patients, who are eligible to join the Senior Medicare Patrol.

The Senior Medicare Patrol (SMP) is a group of more than 5,400 volunteers who are trained to detect fraud, waste, and abuse in the Medicare system. The members of the Patrol also teach other seniors how to recognize fraud and abuse, and how to protect their identities and avoid falling for scams.

The Patrol has been in existence since 1997, and during that 17-year period, its members have recovered more than $114.5 million for Medicare and Medicaid, according to the HHS Office of Inspector General’s recent “Performance Data for the Senior Medicare Patrol Projects: June 2014 Performance Report.”

The SMP Program’s Web page states that the organization teaches its volunteers to watch for fraud and abuse, such as unnecessary or inappropriate services, charges for services never provided, or illegal marketing practices.

The SMP also advises seniors of Medicare and Medicaid scams that they might encounter and offers information on how to identify and report any such scams. In 2013, the program prompted recoveries worth $9.1 million, saving beneficiaries $41,718 and avoiding costs of $143,282 to the Medicare and Medicaid programs, the OIG’s recent report states.

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Some providers have expressed concern that they are being audited even when they are not aware of it. But the program isn’t designed to turn Medicare patients into undercover detectives. Instead, the Senior Medicare Patrol is an education-based program showing Medicare beneficiaries and their families how to watch for Medicare fraud.

Because the SMP is more of an awareness group, they know to question a provider if they are billed for a service they didn’t receive — however, they aren’t necessarily gathering evidence to make legal cases against providers.

If, however, the SMP administrators see a pattern among the volunteers’ reports and find complaints about a particular provider, the agency determines whether they’ve found a trend which might result in them looking at a provider more closely.

Note: To read the OIG’s report on the Senior Medicare Patrol program, visit‑http://oig.hhs.gov/oei/reports/oei-02-14-00140.pdf.