Billions of federal dollars are lost annually due to health care fraud, errors, and abuse. Since 1997, AoA has funded Senior Medicare Patrol (SMP) projects that recruit and train retired professionals and other older adults to recognize and report instances or patterns of health care fraud.
The SMP program empowers older adults through increased awareness and understanding of health care programs. Knowledge helps them to protect themselves from the economic and health-related consequences of Medicare and Medicaid fraud, errors, and abuse. SMP projects also work to resolve beneficiary complaints of potential fraud in partnership with state and national fraud control and consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the HHS Office of the Inspector General (OIG), and CMS.
These activities support AoA’s goals of promoting increased choice and greater independence among older adults. SMP activities also serve to enhance the financial, emotional, physical, and mental well-being of older adults, thereby increasing their capacity to maintain security in retirement, and to make better financial and health care choices.
The National Consumer Protection Technical Resource Center (the Center) provides training and technical assistance to SMP projects, promotes national visibility, and shares best practices. The Center disseminates information for consumers and professionals and maintains an online tool for finding the SMP in each state.
Outputs and Outcomes
The HHS OIG collects performance data from SMP projects semiannually. SMART FACTS, a web-based management, tracking, and reporting system, enables consistent measurement of activities and results, and seamless semiannual reporting of performance outcomes to OIG. The most recent OIG report, dated June 13, 2014, documents the following outcomes from 1997 through 2013:
Education Session: More than 4.4 million beneficiaries have attended group education sessions led by SMP staff who have conducted more than 120,000 sessions.
One-on-One Counseling: More than 1.4 million sessions were held with or on behalf of a beneficiary.
Community Outreach Events: More than 29 million people are estimated to have been reached by SMP community education events.
Media Airings: More than 2.2 media airings conducted by SMP.
Inquiries Received: More than 1.9 million inquiries, including one-on-one counseling and complaints regarding potential fraud, error, or abuse, have been received from beneficiaries, their families, or caregivers.
Savings: About $121 million in savings, including Medicare and Medicaid funds recovered, beneficiary savings, and other savings have been attributed to the project as a result of documented complaints.
Annual Performance Reports
Titles II and IV of the Older Americans Act, (42 U.S.C. 3032), the amendments of 2006 (P.L. 109-365) and the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191).
- Funding History
The Senior Medicare Patrol Program
Funded by the Health Care Fraud and Abuse Control (HCFAC) Program and
Older Americans Act (Title IV) funds
Program 2010 Budget* 2011 Budget* 2012 Budget* 2013 Budget* 2014 Budget* SMP $9.4 $9.4 $9.4 $8.9 $8.9 AoA HCFAC $3.3 $3.3 $10.7 $10.7 $6.6 CMS HCFAC Contribution** $9** $9** $0** $0** $0** TOTAL $12.7 $12.7 $20.1 $19.6 $15.5
* Dollar amounts are in millions
**In 2010 and 2011 the Centers for Medicare and Medicaid Services (CMS) provided the AoA with an additional $9 million per year in HCFAC funds to expand the capacity of the SMP program to better meet the growing demands for fraud detection and prevention. These funds were used to increase the SMP program’s capacity to reach more Medicare beneficiaries, particularly in targeted cities with high risks for fraud. In addition to providing training, education, and outreach, this funding was used to increase the SMP’s ability to respond and resolve inquiries and complaints in a timely manner, and improve coordination of projects with Federal, State, and local officials.
ACL has chosen to continue the SMP program expansion activities, begun in 2010 and 2011 with the support of CMS, by allocating additional HCFAC funds to increase awareness of Medicare and Medicaid beneficiaries of health care fraud prevention, identification and reporting through expansion of SMP program capacity. Additional funding will enable new focused efforts to increase community outreach and education activities and will support building the capacity of the SMP program with an expanded network of trained, professional volunteers.
- Resources and Useful Links
The National Consumer Protection Technical Resource Center (SMP Resource Center) provides training and technical assistance to SMP projects, provides key consumer services such as fraud alerts, and maintains the SMP locator.
- SMP Program Policies and Procedures
Volunteer Risk and Program Management (VRPM)
Volunteer management in the SMP program is challenging and rewarding work. Those who manage volunteer programs are responsible for planning, supporting, and evaluating the delivery of services through volunteers who conduct outreach, give presentations, and counsel. Because the safety of volunteers and beneficiaries is a top priority, volunteer management also involves managing risks through appropriate screening, placement, training, and supervision.
AoA has funded a Volunteer Risk and Program Management (VRPM) project to decrease and manage risks related to volunteer involvement in SMPs and to increase the management and coordination of volunteer efforts.
As part of the VRPM project, AoA developed comprehensive VRPM policies for SMPs. They provide guidance and direction to staff and volunteers, and are designed to enhance the quality, effectiveness, and safety of SMP services.