Since 1997 more than 30 million people have been reached during community education events, more than 6.5 million beneficiaries have been educated and served, and more than 46,000 volunteers have been active. Total savings to Medicare, Medicaid, beneficiaries, and other payers attributed to the SMP projects is more than $122 million. Total cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others is more than $9 million.
In 2014, 53 Senior Medicare Patrol Projects had 5,249 active volunteers. SMP staff and volunteers educated beneficiaries in 14,692 group education sessions. The sessions were attended by 452,714 beneficiaries. SMPs held 202,862 one-on-one counseling sessions, a 37-percent increase from 2013.
The SMP program model is one of prevention. SMPs educated Medicare beneficiaries to scrutinize their medical statements and bills and subsequently reduce fraud and errors. Though beneficiaries have several avenues they can take to report fraud, such as the Office of Inspector General (OIG) hotline or 1-800-Medicare, some beneficiaries choose to report fraud to the SMP. In these cases, SMPs refer the complaint to the appropriate entity.
By the end of 2014, expected Medicare and Medicaid funds recovered that were attributable to the projects were $661,333. Savings to beneficiaries and others totaled $80,228, a 92-percent increase from 2013, and cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $200,598, a 40-percent increase.
The OIG continues to emphasize that it is not always possible to track SMP referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, error, and abuse from the projects. Therefore, SMPs may not be receiving full credit for savings attributable to their work. In addition, SMPs are unable to track the substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries’ scrutiny of their bills.
SOURCE: Office of Inspector General Performance Data for the Senior Medicare Patrol Projects: July 2015 Performance Report