Empowering Seniors To Prevent Healthcare Fraud
The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers, to prevent, detect, and report suspected healthcare fraud, errors, and abuse through outreach, counseling, and education.
Billions of dollars are lost annually because of healthcare fraud, errors, and abuse. The Administration for Community Living (ACL) Office of Healthcare Information & Counseling manages the Senior Medicare Patrol (SMP) grants. SMPs work to resolve beneficiary complaints of potential healthcare fraud in collaboration with state and federal partners, including the U. S. Department of Health & Human Services Office of the Inspector General, Centers for Medicare & Medicaid Services, state Medicaid fraud control units, and state attorneys general.
SMPs recruit and train volunteers to recognize and report potential healthcare fraud. These activities support ACL’s goals of promoting increased choice and greater independence among Medicare beneficiaries.
HISTORY AND STRUCTURE
SMPs are discretionary grant projects funded by the U.S. Administration for Community Living (ACL). The SMP program as we know it today was made possible by the 1997 Omnibus Consolidation Appropriation Act. Since its inception in 1997, the SMP program has evolved from 12 regional demonstration projects to a nationwide program that serves every state, Guam, Puerto Rico, the U.S. Virgin Islands, and Washington, D.C.
SMP Team members are trained to:
•Promote community awareness of healthcare fraud, errors, and abuse.
•Disseminate educational materials about Medicare fraud through presentations, health fairs, and other community events.
•Provide counseling and serve as consumer advocates to resolve billing issues, and
•Make appropriate referrals to state and federal partners for suspected cases of Medicare fraud, errors, and abuse for further investigation.
SMPs are funded by the Health Care Fraud and Abuse Control (HCFAC) program for its antifraud activities. In 2019, approximately 87% of the total funding available was distributed to the state SMP projects to help beneficiaries prevent, detect, and report Medicare fraud, errors, and abuse.
SMP PERFORMANCE OUTCOMES
Each year, the Office of the Inspector General (OIG) completes an annual performance report on the SMP projects. The OIG reports from 2008 through 2023 can be found here:https://smpresource.org/what-smps-do/oig-report/
Wyoming Senior Citizens, Inc. (WSCI) was founded in April 1975 with the mission Statement, “To help Wyoming’s older residents to maintain their independence.” Since that date WSCI has been serving seniors and disabled persons across Wyoming through a myriad of programs with a focus on helping Wyoming’s older person live independently with dignity for as long as possible.
Since 1997, the Senior Medicare Patrol Program has been an integral Part of the agency in assisting Medicare recipients to identify, detect, and report Medicare fraud. Continued education and counseling of Medicare beneficiaries is the key to keeping on top of erroneous billing practices and fraudulent activities. The Wyoming SMP Program does this very well and will continue to serve Wyoming’s seniors into the future.