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Volunteer Program Targets Medicare Fraud

SMPs train seniors to recognize scams

By Susan Hindman

A few older adults are milling around outside a senior center. Someone approaches them and offers to arrange to purchase scooters for them through Medicare. Because they’ll need physicals before being approved for the scooters—and they’ll need a ride—the person offers to drive them as a group to see a doctor, all for free. After a brief check of their vital signs, the seniors go home. And wait. Sometimes the scooter never arrives, but the Medicare statement does; sometimes a cheap scooter shows up, but Medicare is paying for a really nice one. And someone else, the thief who billed Medicare, pocketed the difference.

The double-whammy here is that these seniors have given out their Medicare ID number, so they risk getting a statement for other services they didn’t request and having their identity stolen.

This is one of dozens of scenarios in the world of Medicare fraud. Considering that Medicare provides health insurance to around 44 million elderly and disabled beneficiaries, it’s a daunting task to alert seniors about what’s happening and how to prevent it.

But that’s just what thousands of SMPs are doing. SMPs are senior volunteers—4,685 in 2008—around the country who are working to educate their peers on how to avoid, detect, and prevent fraud, waste, and abuse that occur all too frequently in the Medicare and Medicaid programs. SMPs give presentations in the community, exhibit at events such as health fairs, answer calls to the SMP help lines, and do one-on-one counseling. They teach beneficiaries how to protect their personal identity, identify and report errors on their health care bills, and recognize deceptive practices. When fraud is discovered, SMPs refer it to the next level of investigators.

The SMP program grew out of an anti-fraud project called Operation Restore Trust (ORT), formed in 1995 in five states. Two years later, it expanded and became the Senior Medicare Patrol; in 2006, the name was shortened to SMP. The program is funded and supported by the U.S. Administration on Aging, and the National Consumer Protection Technical Resource Center trains the program directors and serves as the central source of information and technical assistance for the 54 SMP programs that are in every state as well as the District of Columbia, Guam, U.S. Virgin Islands, and Puerto Rico. SMP volunteers have reached around two million seniors.

Recruiting and training volunteers happens at the program offices. Training has varied from state to state—a standardized national training program will be introduced in August—but it’s rigorous.

“Currently we require everyone go through federal training on Medicare so they have a great foundation to understand what Medicare is and why it was created, what it does and doesn’t pay for, and how consumers should be protected,” said Julie Schoen, director of the California SMP program, about the training program in her state. “They have to go through that foundational training, and then they receive SMP training. . . . It’s pretty intense, but you want people to feel secure in what they’re telling other people and to know where they can go for help.”

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What Does Medicare Fraud Look Like? 

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