Senior Medicare Patrol Overview:
Maryland SMP (Senior Medicare Patrol) is an anti-health care fraud project administered by the Maryland Department of Aging through the U.S. Department of Health and Human Services and the Administration on Aging. The mission of Maryland SMP is to develop a program that enlists senior volunteers to teach Medicare and Medicaid clients how to recognize and report health care fraud, waste, abuse, or error.
Medicare Fraud Prevention Week - Beginning 6/5
The Senior Medicare Patrol (SMP) Program created National Medicare Fraud Prevention Week a national week to draw attention to actions everyone can take to prevent Medicare fraud, errors, and abuse. Learn how you can protect yourself and your loved ones from Medicare fraud by joining us on 6/5 to kick off celebrating this week! Click
here.
What is Health Care Fraud?
Every year, health care fraud, waste, abuse and error results in the loss of billions of senior and taxpayer dollars. Examples include:
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Giving false or misleading information that benefits the health provider or service but increases consumer costs.
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Billing for Medicare or Medicaid services, medicine, equipment or supplies not prescribed, not provided or not needed.
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Offering cash, free services, or gift rewards to influence use of a particular doctor, insurance plan, HMO, home health agency, nursing home or other medical services.
- Providing
care or service that is
below accepted standards.
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Stopping insurance coverage or ending services without prior notice or reasonable cause.
Everyone Plays a Part in the Fight Against Fraud
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Medicare beneficiaries can monitor their insurance statements to make sure products and services received match what is on the statements. They can request free My Health Care Trackers from their local SMP.
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Caregivers can help by being on the lookout for items such as durable medical equipment (like boxes of knee braces) lying around the house that may have been shipped to the beneficiary without their or their doctor’s approval. They can remind their client or loved one to never give out their Medicare number or other personal information over the phone.
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Families can help by talking to their loved ones about protecting their Medicare number just as they would a credit card number. They can help their loved ones create a Medicare.gov account to access their Medicare statements online or remind them to open and review them when they come in the mail. They can also register their phone number on “do not call” lists and go to optoutprescreen.com to opt out of mailings.
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Partners and professionals can help by sharing SMP information on social media, referring clients and consumers to the SMP, and inviting the SMP to speak during a shared event.
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Health care providers can help by talking to patients about health care-related scams such as those related to durable medical equipment and genetic testing schemes. They can remind them that products and services should only be ordered by physicians they regularly see. Needed medical items should never be ordered through TV ads or unsolicited calls.
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Community members can help by looking out for older neighbors. When in public, they can be aware of older individuals purchasing gift cards in large amounts. They can encourage those they know to talk to a trusted source about their Medicare questions and tell neighbors about the most recent Medicare scams. They can even consider volunteering with the local SMP.
Services available through SMP include:
- Maryland Trained SMP volunteers who provide free, confidential assistance to senior Medicare and Medicaid consumers to help them learn about, identify and report health care fraud, waste, abuse or error.
- Individual counseling available in person or by phone.
- Home counseling visits for Medicare beneficiaries who are physically unable to visit a Maryland SMP service site.
- Community educational meetings to involve more seniors in the fight against health care fraud, waste, abuse or error.
- Access to information and services through an Internet Web site.
Remember: most health care professionals are honest, trustworthily, and responsible. The goal of this initiative is to weed out the few health care providers who operate with the intention of using Medicare and Medicaid as a pipeline to personal profit. The effort to prevent and detect health care fraud is a cooperative one that involves
EVERYONE:
- The Centers for Medicare and Medicaid Services (CMS), and the Administration on Aging (AoA).
- Providers of services and durable medical equipment regional carriers.
- Federal, state and local agencies such as the Department of Health and Human Services Office of the Inspector General(HHS-OIG), the Federal Bureau of Investigation(FBI), the Department of Justice(DOJ), Office of the Attorney General(OAG), Department of Health and Mental Hygiene(DHMH), Area Agencies on Aging(AAA), and the local Sheriff Offices.
- Medicare and Medicaid Beneficiaries — this means
YOU!
How can you help?
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Report suspected cases of fraud to Maryland SMP.
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Participate in Maryland SMP counseling and educational services.
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Become a Maryland SMP Volunteer
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Protect your Medicare and Medicaid information.
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Detect billing errors.
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Report potential health care fraud, waste, abuse or error.
Common Medicare Fraud Schemes:
Volunteer Opportunities
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.
What SMP Volunteers Do
SMP projects match a volunteer’s skills and interests to the needs of the program. As a result, SMP volunteers may serve Medicare beneficiaries, their families, and caregivers in many creative ways. However, there are six types of activities most commonly conducted by SMP volunteers nationwide:
- Assist with administration: Help with work such as copying, filing, data entry, and placing outbound phone calls in support of SMP activity
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Distribute information: Help with transporting and disseminating SMP information materials to sites and events; may include presenting prepared copy or performing scripted activities for small groups
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Staff exhibits: Help by staffing information kiosks or exhibits at events such as health fairs; also may provide general information about SMP to the public and answer basic questions
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Make group presentations: Help by giving presentations on SMP topics to small and large groups; may interact with the audience by answering questions and through discussion
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Counsel: Help by having direct conversations with beneficiaries about their individual situations; may include a review of personal information such as Medicare Summary Notices, billing statements, and other related financial and health documents
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Manage complex interactions: Help with in-depth interactions with beneficiaries who are reporting specific instances of health care fraud, errors, and abuse; may act on behalf of a beneficiary to correct an error or refer suspected fraud and abuse to the appropriate authorities
