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Senior Medicare Patrol (SMP) - Preventing Medicare Fraud. 25 Years of SMP.

Purpose

Billions of federal dollars are lost annually due to healthcare fraud, errors, and abuse. The Administration for Community Living (ACL) Office of Healthcare Information & Counseling manages the Senior Medicare Patrol (SMP) grants. 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. 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 retired professionals and other volunteers to recognize and report instances or patterns of healthcare fraud. These activities support ACL’s goals of promoting increased choice and greater independence among older adults and individuals with disabilities. SMP activities also serve to enhance the financial, emotional, physical, and mental well-being of older adults, thereby increasing their capacity to maintain security in retirement and make better financial and health care choices.

History and Structure

SMPs were authorized in 1997 under Titles II and IV of the Older Americans Act, the Omnibus Consolidated Appropriation Act of 1997 and the Health Insurance Portability and Accountability Act of 1996. Although SMPs began as demonstration projects in 12 states, they are now present in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. Nationally, the SMP network includes nearly 5,532 team members (staff and volunteers) at more than 500 local sites.

SMP team members are trained to:

Promote community awareness of healthcare fraud, errors, and abuse;
Disseminate consumer education materials about Medicare fraud through presentations, health fairs, and other community events;
Provide counseling, and when needed, serve as consumer advocates to resolve billing disputes/issues; and
Make appropriate referrals to state and federal partners for suspected cases of Medicare fraud, errors, and abuse for further investigation.

In addition to SMP program services, many grantees also offer State Health Insurance Assistance Program (SHIP) services, which provide health insurance counseling, outreach, and training to Medicare beneficiaries, their families, and caregivers.

Funding

SMPs are funded by the Health Care Fraud and Abuse Control (HCFAC) program for its antifraud activities. In 2023 funding for the SMP program totaled approximately $35.2 million. Approximately $32.2 million 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 2023 OIG SMP Performance Report documents the following outcomes for 2021 activities:

Community Outreach Events: SMP projects reached more than 1.2 million people through 22,356 group outreach and education events.
One-on-one Counseling: SMP projects held more than 270,348 individual counseling sessions with, or on behalf of, Medicare beneficiaries regarding potential fraud, errors, or abuse.
Expected Medicare Recoveries: SMP Projects reported $111.3 million in expected Medicare recoveries.
Consumer Fraud Alerts: SMP released consumer fraud alerts:

Past OIG SMP Reports:

Interested in Joining the Senior Medicare Patrol?

The SMP program offers volunteers an opportunity to make an important difference in their communities. Volunteers take pride in working to ensure that the Medicare program will be protected for future generations. Visit the Senior Medicare Patrol Resource Center’s Become a Volunteer webpage to help you decide if joining the SMP program is right for you. The SMP Resource Center website also provides helpful materials for beneficiaries, SMP team members, and program partners; current fraud information; and the SMP Locator, which helps people find their local SMP program.

Resources and Useful Links

Volunteer Risk and Program Management (VRPM) Policies: ACL has developed a set of policies to assist the SMP and SHIP grantees with managing their programs. The policies describe the governing principles and values that shape and guide Team Member involvement, set expectations regarding the management of volunteer programs, delineate core expectations of SMP/SHIP Team Members, and broadly describe what Team Members may expect from the SMP/SHIP. The purpose of these policies is to enhance the quality, effectiveness, and safety of SMP/SHIP services through the provision of guidance and direction to SMP/SHIP staff and volunteers.

Managing Conflicts of Interest: ACL has developed 'Conflict of Interest: Identification, Remedy, and Removal' to provide technical assistance to SHIP/SMP/MIPPA programs and their partner Community-Based Organizations (CBOs) on how to avoid actual and perceived Conflicts of Interest (COI) and mitigate risk.

Senior Medicare Patrol (SMP)