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
• Data Highlight Extensive Services Provided to Seniors
• Funding History
• Resources and Useful Links
  

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.

In addition they are made aware of how threats to financial independence and health status may occur when citizens are victimized by fraudulent schemes. These SMP projects partner with the aging network, as well as community, faith-based, tribal, and health care organizations. Together they utilize a variety of outreach strategies to educate and empower their peers to identify, prevent and report health care fraud. Currently, the SMP program funds 54 projects in all states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.

The SMP program empowers seniors through increased awareness and understanding of healthcare programs. This knowledge helps seniors 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. SMP Integration Grants also assist the projects by developing innovative approaches that improve statewide outreach and beneficiary education on new Medicare provisions.

AoA works in partnership with the HHS Office of Inspector General, the Centers for Medicare and Medicaid Services, the Department of Justice, AARP, the aging network and other federal, state and community-based organizations to address health care fraud control issues.

Through the combination of the Health Care Fraud and Abuse Control (HCFAC) Program and Older Americans Act (Title IV) funds, the Senior Medicare Patrol program has proven successful in reaching older Americans and educating them about the importance of healthcare fraud prevention, identification and reporting.

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 May 18, 2009, documents the following program outputs and outcomes from the inception of the program in 1997 through December 2008:

• Education: Almost 2.6 million beneficiaries have been educated during 67,491 group education sessions led by SMP staff or SMP projects.
  
• Counseling: More than 1.0 million one-on-one counseling sessions were held with or on behalf of a beneficiary.
  
• Events: Over 22 million people are estimated to have been reached by SMP community education events.
  
• Media Outreach: Over 957,000 media outreach events have been conducted.
  
• Resolution of Complaints: Over 113,000 complaints received from beneficiaries, their families or caregivers as a result of educational efforts were resolved or referred for further investigation.
  
• Savings: Over $105.7 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.
  

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The National Consumer Protection Technical 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.

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