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 to do the same.

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.

In 2018, the SMP projects had a total of 6,935 total active team members who conducted 26,932 group outreach and education events, reaching an estimated 1.7 million people. In addition, the projects had 278,761 individual interactions with, or on behalf of, a Medicare beneficiary.

The SMP projects reported $15,136 in expected Medicare recoveries and $5,734 in expected Medicaid recoveries. Cost avoidance totaled $602,063, while savings to beneficiaries and others totaled $27,689. Further, additional Medicare expected recoveries totaled $11.9 million.

The OIG reports that expected recoveries to Medicare and Medicaid attributable to the projects from 1997 through 2018 were $119.7 million. Total savings to beneficiaries and others were approximately $7.1 million. Total cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $10 million.

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: Office of Inspector General 2018 Performance Data for the Senior Medicare Patrol Projects

For More Information

See the OIG Report page.

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