Since 1997 more than 29 million people have been reached during community education events, almost 6 million beneficiaries have been educated and served, and more than 41,000 volunteers have been active. Total savings to Medicare, Medicaid, beneficiaries, and other payers attributed to the SMP projects is $121 million.Total cost avoidance on behalf of the Medicare, Medicaid, beneficiaries, and others is $8.8 million.
In 2013, 54 Senior Medicare Patrol Projects had 5,406 active volunteers, a five-percent increase from 2012. SMP staff and volunteers educated beneficiaries in 14,924 group education sessions. The sessions were attended by 501,405 beneficiaries. SMPs held 148,235 one-on-one counseling sessions, a 31-percent increase from 2012.
The SMP program model is one of prevention. SMPs educated Medicare beneficiaries to scrutinize their medical statements and bill and subsequently reduce fraud and errors, though SMPs are unable to track substantial savings derived from this sentinel effect. 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 2013, expected Medicare and Medicaid funds recovered that were attributable to the projects were $9.1 million, a 50-percent increase from 2012. Savings to beneficiaries and others totaled $41,718, and cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $143,282, a 26-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, waste, 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 the Inspector General Performance Data for the Senior Medicare Patrol Projects: June 2014 Performance Report
The 54 Senior Medicare Patrol Projects engaged 5,406 volunteers, educated 501,405 beneficiaries in group sessions, and held 148,235 one-on-one counseling sessions.