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Fact Sheets
Administration on Aging and ORT
Overview
The United States General Accounting Office estimates that $1 out of every $7 spent on Medicare is paid inappropriately due to error, fraud, or abuse. Last year alone, Medicare lost nearly $13 billion to improper claims.
This problem affects all Americans. It affects those who depend on Medicare and Medicaid by diminishing the quality of the treatment they receive. It affects caregivers by decreasing the funding available for important programs. And it affects everyone who pays taxes by wasting billions of tax dollars.
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Background History
In 1995, the Administration on Aging (AoA) became a partner in a government-led effort to fight error, fraud, and abuse in Medicare and Medicaid through the implementation of a demonstration project called Operation Restore Trust (ORT), which coordinated and targeted federal, state, local and private resources on areas most plagued by abuse.
During its demonstration phase, ORT returned $23 for every $1 spent looking at the fastest growing areas of Medicare, including home health care, skilled nursing facilities, and providers of durable medical equipment. This comprehensive anti-fraud initiative began in five states--California, Florida, Illinois, New York and Texas.
ORT created a partnership in the Department of Health and Human Services between the Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Office of Inspector General, and the Administration on Aging, which are working together today on activities designed to protect the benefit integrity of Medicare and Medicaid. Other critical partners in this effort include AoA’s grantees, health care providers, senior volunteers, beneficiaries and their families, the U.S. Department of Justice, state Medicaid agencies, Medicare contractors, State and Area Agencies on Aging, members of AoA's national aging network, and AARP.
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AoA and ORT
AoA and its national aging network, which includes 57 State Units on Aging (SUAs), 655 Area Agencies on Aging (AAA’s), 221 Tribal Organizations, representing over 300 tribes, and thousands of service providers, play a key role in providing important home and community-based services to older Americans on a daily basis.
AoA focused its initial anti-fraud and abuse efforts on training state and local ombudsmen and ombudsmen volunteers to recognize and report suspected cases of fraud and abuse in nursing homes. It later expanded these efforts by providing training to other aging network personnel, including staff and volunteers of State and Area Agencies on Aging, health insurance counselors, and other service providers.
Throughout the demonstration stage of ORT, AoA staff trained an estimated 2,500 people in the five ORT states, which contributed to the overall collection of $187 million in fines, recoveries, settlements, audit disallowances and civil monetary penalties owed to the federal government.
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Senior Medicare Patrol Projects
AoA has continued to play a key role in anti-fraud and abuse efforts through the enactment of P.L. 104-209, the Omnibus Consolidated Appropriations Act of 1997. Language in this legislation, offered by Senator Tom Harkin (IA), directed AoA to establish demonstration projects that utilize the skills and expertise of retired professionals in identifying and reporting error, fraud and abuse.
These projects are designed to recruit and train retired professionals, such as doctors, nurses, teachers, lawyers, accountants, and others, to work with their peers in their communities to teach older individuals and their families how to take an active role in protecting their health care. In May 1997, AoA first awarded funds to 12 agencies and organizations for this purpose.
Based on the success of these activities, AoA now awards grants to 52 projects, operating in 48 states plus Washington, D.C. and Puerto Rico. Volunteers work in their communities and in local senior centers teaching older Americans and their families how to take a more active role in protecting their health care.
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What Are Fraud and Abuse?
Most health care professionals are honest, trustworthy, and responsible. The goal of ORT is to weed out those few unscrupulous individuals who operate with the intention of using Medicare and Medicaid as a pipeline to personal profit.
Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare and Medicaid fraud generally involves deliberately billing for services that were never rendered or billing for a service at a higher rate than is actually justified.
Health care abuse occurs when providers supply services or products that are medically unnecessary or that do not meet professional standards.
By learning more about this issue and being more observant in their homes and communities, individuals can help fight Medicare and Medicaid error, fraud, and abuse, and the wasting of taxpayer dollars.
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What You Can Do to Help
• Never allow anyone to convince you to contact your physician to request a procedure you do not need.
• Never allow anyone (other than legal representatives such as ombudsmen or legal guardians) to review your medical records or prescription medications without your physician's approval.
• Never give your Medicare number to telephone or door-to-door solicitors.
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Take a Few Simple Steps
• First: Treat your Medicare number as you would your credit card.
• Second: Read your explanation of benefits statement carefully. Call your health care provider if you have any questions.
• Third: Learn more about what you can do to help by calling the local Senior Medicare Patrol Project in your state.
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