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Senior Medicare Patrol helps fight fraud, abuse

Billions of federal dollars are lost annually due to health care fraud, error and abuse. Since 1997 the federal Administration on Aging (AoA) has funded Senior Medicare Patrol (SMP) projects to recruit and train retired professionals and other senior citizens to recognize and report healthcare fraud.

These SMP projects partner with the aging network, as well as community, faith-based, tribal and health care organizations to help their peers identify, prevent and report healthcare fraud. Programs are funded in all 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.

In December 2011, the U.S. Department of Health and Human Services awarded $9 million to help SMP programs across the nation continue fighting fraud. In Texas, the Better Business Bureau Educational Foundation has received a grant of $400,000 to manage the Texas SMP.

What is SMP?

The SMP program helps seniors understand healthcare programs, which in turn helps them protect themselves from Medicare and Medicaid fraud, error and abuse.

SMP projects also work to resolve beneficiary complaints of potential fraud in partnership with state and national fraud control/consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the Office of the Inspector General and the Centers for Medicaid and Medicare Services.

The SMP program also enhances the financial, emotional, physical and mental well-being of older adults — increasing their capacity to stay secure and independent in retirement, and to make better financial and healthcare 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 the online SMP Locator.

The Texas SMP program

The Texas SMP covers the state through partnerships with organizations including  Texas Senior Corps and their RSVP programs, Texas AgriLife Extension, Texas Department of Insurance, and various area agencies on aging.

Texas SMP volunteers use their time and experience to help their peers protect their identity, read their Medicare Summary Notices and avoid getting taken by scammers. They work one-on-one with beneficiaries, give presentations to groups and represent the SMP at events.

The SMPs also prepare volunteers with seminars, personalized help and information they can take home to study. If you are interested in becoming a volunteer with the Texas SMP, call 1-888-341-6187 or email Barbara McGinity at bmcginity@bbbhou.org.

Outputs and outcomes

Since the program’s inception in 1997 through December 2010, the following results have been reported:

  • Education: More than three million beneficiaries have been educated during nearly 83,000 group education sessions led by SMP staff or SMP projects.
  • Counseling: More than 1.1 million one-on-one counseling sessions were held with or on behalf of a beneficiary.
  • Events: More than 25 million people are estimated to have been reached by SMP community education events.
  • Media outreach: More than a million media outreach events have been conducted.
  • Complaint resolution: More than 267,000 complaints received from beneficiaries, their families or caregivers as a result of educational efforts were resolved or referred for further investigation.
  • Savings: About $106 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.

(Jan. 6, 2012)

 

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