Department of Health and Human Services Grant: Combatting Medicare Fraud with Senior Medicare Patrol Projects

Beginning in 1997, the AoA established twelve local demonstration projects designed to recruit and train retired professionals, such as doctors, nurses, teachers, lawyers, accountants, and others to identify and report error, fraud, and abuse. Implemented through the Omnibus Consolidated Appropriation Act of 1997 (Public Law 104-208), Senate Report 104-368 noted that “senior citizens are our best front line defense against these losses, but they often don’t have the information and experience needed” to recognize and accurately report cases of error, fraud, and abuse. The Report further noted that “thousands of retired accountants, health professionals, investigators, teachers, and others … with appropriate training could serve as volunteer expert resources and educators for seniors in their communities.” Accordingly, these projects have worked to test different models designed to train retirees in local communities to serve as both volunteer resources and educators for other Medicare beneficiaries, and to build and strengthen community coalitions of older Americans and service providers.
In 2011, the SMP Program will include an estimated 54 project grants in all states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. SMP projects have made great progress in recruiting and training retired professionals and other senior citizens on Medicare error, fraud and abuse. These volunteers work in their communities, senior centers and elsewhere to educate Medicare beneficiaries, family members, and caregivers to actively protect themselves against fraudulent, wasteful and abusive health care practices by reviewing their Medicare benefit statements and reporting suspected errors.

SMP projects actively work to disseminate SMP fraud prevention and identification
Information through the media, outreach campaigns, community events and many
other means. Through these efforts, beneficiaries contact the projects with inquiries and complaints regarding Medicare, Medicaid and other health care or related consumer issues. Another key role of the SMP project is to address such inquiries and complaints, either by resolving matters directly or by referrals to appropriate entities. SMP projects refer numerous beneficiary complaints to state and national fraud control /consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the OIG, and the Centers for Medicare & Medicaid Services (CMS). Capturing SMP program activity data, to include tracking and reporting of beneficiary complaints, referrals, savings and other outcomes in the SMART FACTS system is also a key function of the SMP project.

The AoA also receives Health Care Fraud and Abuse Control (HCFAC) funding as authorized by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The HCFAC funds, which are received from the Medicare Trust Fund, are used to support infrastructure, technical assistance, and other SMP program support and capacity-building activities designed to enhance program effectiveness. The National Consumer Protection Technical Resource Center (the Center), an AoA grantee, provides training and technical support including mentoring of new projects, disseminating best practices and innovations, technical assistance, training and support of SMP project implementation and effective use of AoA’s SMART FACTS management tracking and reporting system. In addition, HCFAC funding supports a National Hispanic SMP project focused on targeted outreach to Hispanic beneficiaries, their families and caregivers.