A tip of the hat to Senior Medicare Patrols


September is healthcare fraud awareness and prevention month, and that makes this a good time to acknowledge the work of Senior Medicare Patrols. SMPs are a national project run by states to teach citizens to prevent, detect and report Medicare and Medicaid fraud, error and abuse. The SMPs are a dynamic force for good. They remind us that fraud isn't something we should passively accept.

Highly-trained SMP volunteers work one-on-one with beneficiaries, make group presentations and represent SMPs at events. Their work is an interactive, grassroots effort to spread the message of fraud prevention to friends and neighbors in their communities.  

It can be difficult enlisting public support to fight healthcare fraud. Surveys have consistently shown that customers dislike insurance companies and don't want to engage with them, as FierceHealthPayer reported. Some people have no qualms about stealing from insurers or the government since they don't consider them sympathetic fraud victims. And some customers don't see how healthcare fraud takes money from their wallets.

But SMPs stand in sharp contrast to this. Since 1997, SMP projects have received more than 300,000 complaints for investigation and recorded more than $106 million in savings according to U.S. the Department of Health and Human Services.

For a snapshot of how the program works at the state level, I recently spoke to Kevin Brown, project director of the Wisconsin SMP. He reported that the Wisconsin project trained more than 1,700 volunteers to teach Medicare beneficiaries, family members and caregivers to protect personal health information, review Medicare notices for billing errors and report suspected fraud, waste and abuse. The Wisconsin SMP now has about 50 active volunteers statewide. Along with the state's SMP staff, these volunteers made over 1,100 presentations on fraud and distributed informational material at more than 800 community events in the past 17 years. The Wisconsin SMP also educates the public through a monthly publication, a website and a Facebook page.

It's encouraging to see the dedication of SMP volunteers like Iowa's June Richardson. Affectionately known as "the Scam Gram," Richardson submitted more complaints for investigation than any other SMP volunteer in her state.

And 136 SMP volunteers in Florida logged in more than 3,000 volunteer hours and contacted more than 62,800 people about healthcare fraud, as FierceHealthFinance reported. Their work resulted in 788 calls to a Medicare fraud hotline, according to federal officials.

All this activism makes a difference because fraud flourishes in the dark. The SMPs give us many new eyes in the field, eyes that are trained to thwart crime.

The SMPs are drawing a line in the sand against fraud, and their work sends powerful messages to would be-criminals. No, we won't disclose our health insurance or checking account numbers in response to out-of-the-blue phone solicitations. No, we won't be bullied into letting you order "free" medical equipment for us that we don't need. And if you claim payment for services we didn't receive, we'll report that.

Overall, the SMPs are making it harder for criminals to treat Medicare and Medicaid like low-hanging piñatas. And for that, we owe SMPs our thanks.   

I'm reminded of the words of anthropologist Margaret Mead: "Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has." Jane (@HealthPayer)

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