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Recent Industry News

Department of HHS OIG

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The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued a memorandum report presenting 2016 performance data on the Senior Medicare Patrol (SMP) program.  SMP projects aim to fight against Medicare errors, fraud, and abuse.  The SMP program is designed to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report such issues.  The Administration for Community Living (ACL) provides grant funding for SMP projects.  In turn, the SMP projects involve recruiting and training retired professionals and other senior citizens to carry out Medicare error, fraud, and abuse prevention, detection and reporting activities.  Their work involves conducting presentations, presenting exhibits at events, working one-on-one with Medicare beneficiaries, and engaging volunteers to protect elderly person’s health, finances, and medical identity.  SMP project volunteers receive beneficiary complaints and determine whether they may involve fraud, errors, or abuse.  When fraud or abuse is suspected, these volunteers make referrals to the appropriate state and federal agencies for further investigation.

The OIG Memorandum

The OIG memorandum reported on five performance measures pertaining to recoveries, savings, and cost avoidance, and another five performance measures relating to volunteer and outreach activities.  The ACL requires all SMP projects to track and report on these measures and on complaints received using the SMP Information and Reporting System (SIRS) implemented in 2015.  The OIG presented the 2016 SIRS data in its report.

The OIG reported the following findings:

  • There were 53 SMP projects in 2016, one in each state and in the District of Columbia, Puerto Rico, and Guam;
  • SMP projects involved 6,126 active team members;
  • SMP volunteers conducted 26,220 group outreach and education events, reaching an estimated 1.5 million people;
  • SMP projects resulted in 195,386 individual interactions with, or on behalf of, a Medicare beneficiary;
  • In 2016, the SMP projects allowed Medicare, Medicaid, beneficiaries, and others to avoid $163,904 in costs;
  • In total, beneficiaries and others saved $53,449, and Medicare expected recoveries of $2,672;
  • Federal prosecutors used information from two 2016 SMP projects to arrive at settlements, totaling $9.2 million in expected Medicare recoveries; and
  • The 2016 SMP projects did not result in any expected Medicaid recoveries.

The OIG report reflected a significant increase in cost avoidance amounts from the previous year, when totals amounted to $21,533.  Beneficiary savings were somewhat higher in 2016, up from $35,059 in 2015.  In terms of Medicare recoveries, however, the SMP projects reported significantly lower expected recoveries; the total amount lowered to $2,672 from $2.5 million in 2015.

The OIG noted that its report may not reflect additional recoveries, savings and cost avoidance attributable to the SMP projects.  Referrals to Medicare contractors or law enforcement, from beneficiaries who have learned to detect fraud, waste, and abuse through the SMP projects, are difficult to track.  Further, the OIG and SMP projects are unable to track the potential savings gained from Medicare beneficiaries applying more scrutiny to their Medicare bills.

The OIG Report is available at: https://oig.hhs.gov/oei/reports/oei-02-17-00220.pdf.

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