The Senior Medicare Patrol programs (SMP) help Medicare and Medicaid beneficiaries detect, avoid and prevent health care fraud. In doing so, they not only protect older persons, but also help preserve the integrity of the Medicare and Medicaid programs. Because this work often requires face-to-face contact to be most effective, SMPs recruit nationwide and teach nearly 5,700 volunteers every year to help in this effort. Most SMP volunteers are both retired and Medicare beneficiaries and thus well-positioned to assist their peers.
How the Program Works
SMPs are funded by the U.S. Administration on Aging (AoA). They receive technical assistance from the National Consumer Protection Technical Resource Center. Financial support from AoA and technical support from the center are not enough to maintain the accomplishments of the SMPs. SMPs rely on the efforts of thousands of volunteers and hundreds of partnerships at the community, state and national levels. There are many volunteer opportunities available within the SMP program, and ways your organization can partner with SMPs.
SMP activities support AoA's goals of promoting increased choice and greater independence among older adults. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults – thereby increasing their capacity to maintain security and independence in retirement and to make better financial and health care choices. You can find more information about the SMP program from AoA, and locate an SMP in your area.
SMP staff and their highly trained volunteers conduct outreach to Medicare and Medicaid beneficiaries in their communities through group presentations, exhibiting at community events, answering calls to the SMP help lines and one-on-one counseling. Their primary goal is to teach Medicare beneficiaries how to protect their personal identity, identify and report errors on their health care bills, and identify deceptive health care practices, such as illegal marketing, providing unnecessary or inappropriate services, and charging for services that were never provided. In some cases, SMPs do more than educate: When Medicare and Medicaid beneficiaries are unable to act on their own behalf to address these problems, the SMPs work with families, caregivers and others to address the problems, and if necessary, make referrals to outside organizations who are able to intervene.
History of the program
In 1995, the Administration on Aging became a partner in a government-led effort to fight fraud, error and abuse in the Medicare and Medicaid programs through the implementation of a groundbreaking demonstration project called Operation Restore Trust (ORT). ORT's purpose was to coordinate and target federal, state, local and private resources on those areas most plagued by abuse. Operation Restore Trust was announced at the 1995 White House Conference on Aging.
During its demonstration phase, ORT returned $23 for every $1 spent looking at the fastest-growing areas of Medicare fraud, including home health care, skilled nursing facilities and providers of durable medical equipment. This comprehensive antifraud initiative began in five states: California, Florida, Illinois, New York and Texas. It created a partnership in the Department of Health and Human Services between the Centers for Medicare & Medicaid Services, the Office of Inspector General and the Administration on Aging, which continue to work as a team in a coordinated anti-health-care fraud effort at the local, state and national levels.
AoA became a key player in the fight against fraud through the enactment of P.L. 104-209, the Omnibus Consolidated Appropriations Act of 1997. Language in this legislation, offered by Sen. Tom Harkin (D-Iowa), was adopted, directing the AoA to establish demonstration projects that utilize the skills and expertise of retired professionals in identifying and reporting error, fraud and abuse.
AoA funds 55 SMP projects (each state, Guam, Puerto Rico, the Virgin Islands and Washington, D.C., plus the National Hispanic SMP) to recruit and train retired senior volunteers. At community events, volunteers teach their peers to protect themselves against fraud. They discuss how to safeguard Medicare numbers and examine Medicare Summary Notices and other explanations of benefits to detect discrepancies and report any suspicious activity.
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