Office of Healthcare Information and Counseling
Senior Medicare Patrol (SMP)
Authorizing Legislation: Titles II and IV of the Older Americans Act, (42 U.S.C. 3032), the amendments of 2006 (P.L. 109-365) and the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191)
The Purpose of the Program and How it Works
Billions of federal dollars are lost annually due to health care fraud, error and abuse. Since 1997 AoA has funded SMP projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud.
The SMP program empowers seniors through increased awareness and understanding of healthcare programs. This knowledge helps them to protect themselves from the economic and health-related consequences of Medicare and Medicaid fraud, error and abuse. SMP projects also work to resolve beneficiary complaints of potential fraud in partnership with state and national fraud control/consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the OIG and CMS.
These activities support AoA’s goals of promoting increased choice and greater independence among older adults. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults — thereby increasing their capacity to maintain security and independence in retirement, and to make better financial and healthcare choices.
The National Consumer Protection Technical Resource Center (the Center) provides training and technical assistance to SMP projects, promotes national visibility and shares best practices. The Center disseminates information for consumers and professionals and maintains the online SMP Locator.
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Outputs and Outcomes
The HHS Office of the Inspector General (OIG) collects performance data from the SMP projects semiannually. SMART FACTS–the SMP web-based management, tracking and reporting system—enables consistent measurement of activities and results, and seamless semiannual reporting of performance outcomes to the OIG. The most recent OIG report, dated June 13, 2014, documents the following program outputs and outcomes from the inception of the program in 1997 through December 2013:
- Education Session: Over 4.4 million beneficiaries have attended group education sessions led by SMP staff members who have conducted more than 120,000 group education sessions.
- One-on-One Counseling: More than 1.4 million one-on-one counseling sessions were held with or on behalf of a beneficiary.
- Community Outreach Events: Over 29 million people are estimated to have been reached by SMP community education events.
- Media Airings: SMP has conducted over 2.2 media airings
- Inquiries Received: Over 1.9 million inquiries, including one-on-one counseling and complaints regarding potential fraud, error or abuse, have been received from beneficiaries, their families or caregivers as a result of educational efforts.
- Savings: About $ 121 million in savings, including Medicare and Medicaid funds recovered, beneficiary savings and other savings have been attributed to the project as a result of documented complaints.
OIG Annual Performance Reports:
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The Senior Medicare Patrol program is funded through the combination of the Health Care Fraud and Abuse Control (HCFAC) Program and Older Americans Act (Title IV) funds.
|CMS HCFAC Contribution**
* Dollar amounts are in millions
**In 2010 and 2011 the Centers for Medicare and Medicaid Services (CMS) provided the AoA with an additional $9 million per year in HCFAC funds to expand the capacity of the SMP program to better meet the growing demands for fraud detection and prevention. These funds were used to increase the SMP program’s capacity to reach more Medicare beneficiaries, particularly in targeted cities with high risks for fraud. In addition to providing training, education, and outreach, this funding was used to increase the SMP’s ability to respond and resolve inquiries and complaints in a timely manner, and improve coordination of projects with Federal, State, and local officials.
ACL has chosen to continue the SMP program expansion activities, begun in 2010 and 2011 with the support of CMS, by allocating additional HCFAC funds to increase awareness of Medicare and Medicaid beneficiaries of health care fraud prevention, identification and reporting through expansion of SMP program capacity. Additional funding will enable new focused efforts to increase community outreach and education activities and will support building the capacity of the SMP program with an expanded network of trained, professional volunteers.
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Resources and Useful Links
The National Consumer Protection Technical Resource Center, also known as the SMP Resource Center, provides training and technical assistance to SMP projects, provides key consumer services such as fraud alerts and maintains the SMP locator by state.
SMP Policies and Procedures provide a national framework for the SMP program and projects. Initially created by the Volunteer Risk and Program Management Project, begun in 2009, the policies and procedures aim to decrease and manage risks related to volunteer involvement in SMPs and increase the management and coordination of volunteer efforts.
SMP Volunteer Training has been created for SMP volunteers and staff.
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