Senior Medicare Patrol Helps to Stop Medicare Fraud

The Senior Medicare Patrol (SMP) consists of volunteers who donate their time and energy to teach others about fraud in Medicare and Medicaid. These volunteers are well-versed on how to detect, prevent, and report fraud. The Senior Medicare Patrol believes that this will help to protect our citizens’ health and health benefits, as well as strengthen the Medicare and Medicaid programs.

According to the Senior Medicare Patrol website, they focus their work in three areas:

  1. Conduct Outreach and Education. SMPs give presentations to groups, exhibit at events, and work one-on-one with Medicare beneficiaries. Since 1997 more than 30 million people have been reached during community education events, more than 6.5 million beneficiaries have been educated and served, and more than 46,000 volunteers have been active.
  2. Engage Volunteers. Protecting older persons’ health, finances, and medical identity while saving precious Medicare dollars is a cause that attracts civic-minded Americans. The SMP program engages over 5,200 volunteers nationally who collectively contribute more than 155,000 hours each year.
  3. Receive Beneficiary Complaints. When Medicare beneficiaries, caregivers, and family members bring their complaints to the SMP, the SMP makes a determination about whether or not fraud, errors, or abuse is suspected. When fraud or abuse is suspected, they make referrals to the appropriate state and federal agencies for further investigation.

The Senior Medicare Patrol volunteers are seniors and professionals such as doctors, nurses, investigators, independent insurance agents, law enforcement personnel, attorneys, and teachers.

In 2011, there were more than 5,600 active volunteers in the Senior Medicare Patrol. Some of their accomplishments include:

  • Referring more than 800 complaints for investigation
  • Educating and empowering over 11,000 groups and more than 4.3 million Medicare recipients
  • Holding more than 66,000 one-on-one consultations

Since 1997, Senior Medicare Patrol projects have trained more than 30,000 volunteers and received more than 300,000 complaints for investigation. From those efforts, they have amassed more than $106 million in funds recovered by Medicare and Medicaid, as well as individuals receiving benefits.

Medical Identity Theft

One of the most impacted areas of fraud is identity. Over 250,000 Medicare beneficiaries have had their Medicare claim number stolen or misused. This is known as Medical Identity Theft. Medicare numbers are linked to a Social Security number of someone of either themselves or a spouse who qualified for benefits. They cannot be changed. Once someone’s Medicare ID number has been compromised, their future benefits could be at risk.

Impact On Your Health

Senior patient looking at camera with doctor working on background

Receiving care from someone posing as a healthcare provider could be dangerous at best. These fraudulent providers will not provide quality care and their care could actually be harmful. If receive legitimate care from a physician after receiving care from a fraudulent provider, your new physician may treat you based on previous medical records that are inaccurate.

Additionally, since Medicare has limitations on some of their benefits, you could actually be denied the care that you need. They may think you have already received care that you did not and therefore limit your benefits based on false information.

Impact on Personal Finances

Fraud in Medicare and Medicaid costs all of us. They cost taxpayers unnecessary extra expenses. Fraud also causes higher co-pays and deductibles because Medicare bases those numbers on how much it pays out each year. If it is paying for fraudulent claims, that affects everyone using their services.

You could also find yourself stuck with bills that you don’t really owe. If a provider that should have billed Medicare instead bills the patient for the full cost, that causes an issue.

Lastly, as mentioned above, your Medicare claim number is tied to your or your spouse’s Social Security Number. Once a thief has that they can open credit and bank accounts in your name. Those numbers are of great value to thieves.

The Cost of Fraud

The Medicare program loses billions of dollars each year due to fraud, errors, and abuse. These are our tax dollars. In 2014, the National Health Care Anti-Fraud Association estimated these losses at $60 billion annually, though the exact figure is impossible to know. The most commonly cited range for all health care fraud estimates is 3 to 10 percent of annual health care expenditures. 2012 Medicare expenditures were nearly $600 billion and are expected to rise as the baby boomer population ages.

What Can You Do?

Make sure that you read over any notices you receive from Medicare. A Medicare Summary Notice is sent to those on original Medicare with a Medicare Supplement plan. Those on Medicare Advantage plans and Part D drug plans will receive an Explanation of Benefits (EOB). Check them carefully. If you don’t understand the information on there, have your Medicare agent help you.

These two types of notices will tell you:

  • What the health care provider billed for
  • The amount approved by Medicare for payment
  • How much Medicare paid
  • What the beneficiary may be billed for

Detect Potential Fraud, Errors, or Abuse

  • Review your Medicare statements when you receive them. Be sure you actually received all of the services listed on the statement.
  • Keep a written record of your healthcare visits including what services and tests were provided.
  • Compare your written record to what is on the statement. If they don’t match up, contact your provider or insurance company to discuss discrepancies.
  • You can see your most recent statements at the MyMedicare.gov website. You can also track your claims for up to three years and see if your provider has been paid on their site. Registration and use of this feature is free.

Conclusion

So you can see that the work of Senior Medicare Patrol is very important. We all owe those volunteers a huge pat on the back for their patriotic service to all of us in helping attack fraud and waste. If you would like to volunteer for this service, you can click here to contact your local office.

 

The advice on this website is informational. Please consult us before making a purchasing decision to determine what is best for your individual situation. You can contact Keith Murray at 888-228-6119 or keith@expertmedicare.com.

Keith Murray is an independent agent and the owner of Integrity Senior Solutions Inc. He has over 22 years of experience working with Seniors to meet their insurance and financial needs.

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