Welcome to today’s episode, which covers Medicare fraud.  The Medicare Strike Force and the Health Insurance Preventive Enforcement Action Team (HEAT) exist to stop fraud in its tracks.  Do you think fraud is a widespread problem?  Take a look at the statistics:  in 2011, $15-60 billion was lost to Medicare fraud, and the Center for Medicare Services (CMS) predicts that $65 billion yearly is issued in error.  Those are huge numbers!  My guest today will  help explain the ongoing efforts to stop the fraud!
Anne Frederickson works for one of the volunteer programs trying to help in the fight against fraud.  Ann is a project manager in Ohio for the Senior Medicare Patrol at Pro-Seniors, which is a non-profit, long-term care and advocacy program in Cincinnati.  Ann has been in this position since 2002, and has also worked in geriatrics and hospital administration for 30+ years.  Ann hosts a weekly radio program, “Medicare Moment” on WMKV 89.3 FM.
Explain what Senior Medicare Patrol (SMP) is all about.
SMP volunteers help Medicare and Medicaid beneficiaries prevent, detect, and report potential fraud.  Across the state of Ohio, there are 3 paid staff members and 50 trained volunteers.  The SMP program exists in all 50 states and US territories.
Tell us about the background of the SMP program.
The program began in 1995 as part of Operation Restored Trust (ORT) in partnership with the Department of Health and Human Services and the Center for Medicare Services.  The push to institute the program was spearheaded by two senators from Iowa.
What exactly do the volunteers in the SMP do?
Volunteers do outreach and group presentations, manage exhibits at health fairs and events, and help with one-on-one counseling.  Their “bible” is a personal health care journal, which is a tool to record information from health care providers.  Beneficiaries are encouraged to use the journal to keep track of their information.  Nationwide, SMP volunteers have recovered $106 million for Medicare and Medicaid.  They also seek to educate people to detect fraud and abuse.
What are some examples of the kinds of fraud SMP volunteers would find?

Billing for services and/or supplies never provided
Luring beneficiaries into providing Medicare numbers for free services, and then billing Medicare
Equipment or insurance plan providers tricking senior center participants into giving up their personal information

What advice can you give about fraudulent calls during this open enrollment time?
NO ONE calls a senior and asks for any information unless they are the agent of record that has already been dealing with the beneficiary.  You can put your phone number on the DO NOT CALL list, which subjects callers to severe fines if they violate.  Many states also have programs with access to free information.  Call the SMP about anything that looks suspicious on your monthly summary notices.  DO NOT ever be reluctant to call when you have questions.  The Fraud Hotline is 866-357-6677.
How do listeners get involved and learn more about SMP?
The best way is to visit the website at www.smpresource.org.  There is a drop-down menu for each state.  Online training is available, along with group education training and one-on-one training.
Are people allowed to donate to the SMP?
YES!  It’s best to contact your local group.  All SMP’s are hosted by local non-profit community groups, a state agency, or local county agency.
Would you like to tell us briefly about your radio show?
The show is “Medicare Moment,” and airs on public radio.  It features different guests who talk about health care topics, Medicare, Social Security, and other subjects for seniors and caregivers.  The 15-minute show airs weekly on WMKV FM.
Resources:
www.stopmedicarefraud.gov
www.smpresource.org
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Find out more information about Medicare on Diane Daniel’s website!
 www.Cal