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 coronavirus disease 2019 (COVID-19) pandemic presented many challenges for the SMP projects that limited their in-person activities. For example, in lieu of conducting in-person outreach events, the projects conducted live webinars or teleconferences and recorded presentations or public service announcements.

In 2020, the SMP projects had a total of 5,720 total active team members who conducted 9,870 group outreach and education events, reaching an estimated 425,103 people. In addition, the projects had 249,134 individual interactions with, or on behalf of, a Medicare beneficiary.

The SMP projects reported $16.8 million in expected Medicare recoveries. Cost avoidance totaled $53,768, while savings to beneficiaries and others totaled $33,554.

In addition, the SMP program released a consumer fraud alert on COVID-19 in 2020. The alert warns beneficiaries about potential fraud schemes involving COVID-19 vaccines and treatments. It 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 350 group education events covering COVID-19 fraud issues in 2020, reaching a total of 11,775 people. In addition, they conducted 578 instances of media outreach on this topic, reaching 14.8 million people.

The SMP program also continued from 2019 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 641 group education events covering genetic testing fraud issues in 2020; these events reached 24,443 people. In addition, they conducted 102 instances of media outreach on this topic, reaching 850,374 people.

The OIG reports that expected recoveries to Medicare and Medicaid attributable to the projects from 1997 through 2020 were $138.9 million. Total savings to beneficiaries and others were approximately $7.2 million. Total cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $10.2 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: 2020 Performance Data for the Senior Medicare Patrol Projects

For More Information

See the OIG Report page.

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