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HHS expands initiative to protect Medicare and seniors from fraud

Medicare awards grants to expand 52 Senior Medicare Patrol programs

The U.S. Department of Health and Human Services (HHS) announced today the award of $9 million from the Centers for Medicare & Medicaid Services (CMS) to help Senior Medicare Patrol (SMP) programs across the nation continue their work fighting Medicare fraud.  This is part of President Obama’s initiative to educate people with Medicare about how to protect themselves and Medicare from fraud.  SMPs rely on approximately 5,000 volunteers nationwide to enhance their efforts.

“CMS is committed to working with partners like the Administration on Aging to develop and implement long-term solutions and a collaborative approach to eliminating health care fraud and abuse,” said Peter Budetti, CMS deputy administrator and director of the Center for Program Integrity.  “We’ve dedicated $9 million in grants this year on top of another $9 million last year to expand the state-based Senior Medicare Patrol Programs, which are vital to empower seniors to identify and fight fraud.”

The SMP program is operated by the Administration on Aging (AoA) in close partnership with CMS and the HHS Office of Inspector General.   In June 2010, CMS announced funding for the SMP expansion initiative in conjunction with President Obama’s appearance at a senior center in Wheaton, Md., along with HHS Secretary Kathleen Sebelius.  The 2011 grants will provide additional funds for SMPs to increase awareness among Medicare beneficiaries about how to prevent, detect, and report health care fraud.  Increased funding levels for states identified with high-fraud areas will support additional targeted strategies for collaboration, media outreach and referrals.  The Administration on Aging will continue to administer these grants in partnership with CMS.

“This demonstrates AoA’s and CMS’ shared commitment to educate beneficiaries so they can protect themselves and Medicare as a whole,” said Assistant Secretary for Aging Kathy Greenlee.  “I thank the Centers for Medicare & Medicaid Services for their continued partnership in this effort to educate seniors about health care fraud.”

The SMP volunteers work in their communities to educate Medicare beneficiaries, family members, and caregivers about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity.  Program volunteers also encourage seniors to make inquiries to the SMP Program when such issues are identified, so that the project may ensure appropriate resolution or referral.

Since 1997, HHS has funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior volunteers about how to recognize and report instances or patterns of health care fraud.  More than 4 million Medicare beneficiaries have been educated since the start of the program, through more than 1 million one-on-one counseling sessions with seniors or their caregivers. More than 25 million people have already participated in community outreach education events. 

The Senior Medicare Patrol is just one way HHS is working to fight fraud and strengthen Medicare.  In FY 2010, more than $4 billion was returned to the Medicare Hospital Insurance Trust Fund, the U.S. Department of the Treasury, and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. The Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account. In addition, the Affordable Care Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across federal and state governments, expands overpayment recovery efforts, and provides greater oversight of potential abuses.

A list of the grants awarded to each SMP may be found at: 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/SMP/doc/SMP_Grants_Awards_FY2011.pdf

For more information on fraud prevention efforts, visit: 

http://www.stopmedicarefraud.gov/ or http://www.medicare.gov/navigation/help-and-support/fraud-and-abuse/fraud-and-abuse-overview.aspx?AspxAutoDetectCookieSupport=1.

For information about the SMP program go to http://aoa.gov/AoARoot/AoA_Programs/Elder_Rights/SMP/index.aspx.

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