SMP Program

SMP Results

The SMP projects receive grants from the Administration for Community Living (ACL) to recruit and train retired professionals and other older adults and community members to prevent, recognize, and report health care fraud, errors, and abuse. These SMP team members then participate in outreach events to help educate Medicare and Medicaid beneficiaries on the same prevention, recognition, and reporting techniques.

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.

The COVID-19 pandemic continued to present challenges for the SMP projects that limited their in-person activities. During this period, the projects conducted virtual outreach including live webinars, teleconferences, recorded presentations, public service announcements, group listserv emails, and telephone calls. Where local restrictions and beneficiary and team member comfort and safety allowed, in-person outreach and education events were also held. As a result, the performance data for 2021 do not reflect a normal year of activities for the projects. 

In 2021, the 54 SMP projects had a total of 5,346 active team members who conducted a total of 12,660 group outreach and education events, reaching an estimated 556,980 people. In addition, the projects had 239,625 individual interactions with, or on behalf of, a Medicare beneficiary.

For 2021, the SMP projects reported $2.5 million in expected Medicare recoveries. Over half of these recoveries came from one project that uncovered a genetic testing fraud scheme in which residents of senior housing complexes were persuaded to submit genetic test specimens to a laboratory without sufficient involvement of a health care professional. The company involved was ordered to pay over $1.4 million in restitution. In addition, cost avoidance in 2021 totaled $41,498, while savings to beneficiaries totaled $40,798 for all SMP projects. 

In addition, the SMP program released a consumer fraud alert on hospice in 2021. The alert warns beneficiaries about potential fraud schemes that involve unsolicited marketing tactics to enroll beneficiaries in hospice services. It advises beneficiaries to be sure that their doctor has assessed their condition and certified that they are terminally ill and expected to live six months or less. The alert also advises beneficiaries never to accept gifts in return for hospice services and to be wary of “too-good-to-be-true” offers. The SMP projects conducted 304 group education events covering hospice fraud issues in 2021, reaching a total of 11,795 people. In addition, they conducted 101 instances of media outreach on this topic, reaching 17.3 million people.
The SMP program also continued its educational outreach on fraud schemes involving COVID19. Its fraud alert on COVID-19 advises beneficiaries to be suspicious of strangers offering free COVID-19 testing, supplies, treatments, or vaccines. The alert also advises beneficiaries to be cautious about sharing their personal information, including their Medicare identification number, because this information can be used in fraud schemes. The SMP projects conducted 645 group education events covering COVID-19 fraud issues in 2021, reaching a total of 26,704 people. In addition, they conducted 454 instances of media outreach on this topic, reaching 21.4 million people.
In addition, the SMP program continued its educational outreach on fraud schemes involving genetic testing. Its fraud alert on genetic testing advises beneficiaries to be suspicious of strangers who offer free genetic tests. The alert also cautions beneficiaries about sharing personal information that can be used fraudulently. The SMP projects conducted 505 group education events covering genetic testing fraud issues in 2021; these events reached 24,562 people. In addition, they conducted 144 instances of media outreach on this topic, reaching 17.2 million people.
In comparison to 2020, the projects reported a four-percent decrease in the number of individual interactions in 2021 (239,625, down from 249,134). The number of group outreach and education events increased by 28 percent, and the number of people reached through these channels increased by 31 percent (to 556,980, up from 425,103). In addition, the projects reported lower amounts for Medicare recoveries ($2.5 million, down from $16.8 million), while cost avoidance also decreased ($41,498, down from $53,768).

The OIG notes that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work. It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of their bills reduces fraud and errors.

SOURCE: 2021 Performance Data for the Senior Medicare Patrol Projects

For More Information

See the OIG Report page.

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