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Senior Medicare Patrols

The Office of the Inspector General (OIG) recently released a report on the effectiveness of the Senior Medicare Patrol (SMP) program in 2015. The SMP program was established back in 1997 to detect, prevent, and report health care fraud and abuse through outreach, education, and counseling. It acts as an official organization of Medicare recipients who report fraud, abuse, and misuse of funds. The vital role of the SMP program is to ensure protection of health and health benefits of American public along with the safety of federal healthcare programs from wasting any extra money than required.

The SMP program is funded through endowment offered by HHS’s Administration for Community Living (ACL), which trains volunteers’ in order to trace fraud, abuse, and overuse of funds  in health care. The trained senior volunteers conduct presentations or personnel sittings to educate a broad range of Medicare and Medicaid beneficiaries on topics like how to protect beneficiaries’ identity and how to avoid being victims of scams. SMP volunteers also inform them about the latest updates through Medicare summary notices.

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Medicare Recoveries

OIG reported that there is at least 1 SMP program in each of the 50 states in the US, which collected $17.6 million in funding for total SMP program in the year 2015. Besides that, ACL has come up with a new SMP Information and Reporting System (SIRS) for better access to effectiveness of SMP program, which reported that the program generated 2.5 million dollars in anticipated recoveries for Medicare programs throughout 2015. This is around 282 % raise from the previous year.

Even though the amount of recoveries for Medicare is promising, the total expenditure of the program is well over $6oo million. However, the result shows that the move is in right direction. Since 1997, when SMP was first introduced, it has led to recoveries of around $23 million.

There may be many other recoveries or cost savings that should have been credited to the SMP program, but it is impossible to track these savings in some cases. The most probable instant of undetected savings is generated in case of Medicare recipients, who prevented waste and fraud as a result of awareness gained through the SMP program. Yet these savings are not available through any reporting system; if included anyhow, it could have resulted in a better increase in recoveries.