Medicare Compliance & Reimbursement

Your Medicare patients are more likely than ever to have been trained on ferreting out fraud and abuse in the Medicare program. The Department of Health and Human Services' Senior Medicare Patrol Projects, an HHS initiative designed to educate Medicare beneficiaries on ways to weed out fraud and abuse in federal health care programs, is still going strong. According to the HHS Office of Inspector General, nearly 1.1 million beneficiaries have been trained since the first projects were launched in 1997. Project data indicates that 34,700 volunteers have conducted more than 200,000 training sessions to hit that mark - which is showing some bottom line results. Seniors educated under the project have made more than 23,000 complaints, about one tenth of which were taken up by investigative agencies. In total, closed investigations have racked up more than $80 million for Medicare and other payors. But that's not the end of the story, the OIG points out in "Performance Data for the Senior Medicare Patrol Projects: March 2003 Performance Report" (OEI-02-03-00120). Many beneficiaries trained under the projects have been calling the OIG's own fraud hotline or other contacts to report fraud and abuse. Since the projects don't track that sort of referral, the projects "are not receiving full credit for saved funds attributable to their work," the watchdog agency maintains.