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Report (OEI-02-12-00190)

06-21-2012
Performance Data for the Senior Medicare Patrol Projects: June 2012 Performance Report

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Summary

WHY WE DID THIS STUDY

This memorandum report presents performance data for the Senior Medicare Patrol Projects. OIG has collected these data since 1997. In July 2010, the Administration on Aging (AoA), which is now part of ACL, requested that OIG continue to collect and report performance data for the Senior Medicare Patrol Projects to support AoA's efforts to evaluate and improve the performance of these projects. OIG currently collects performance data every 6 months and reports the data on an annual basis.

HOW WE DID THIS STUDY

This review is based on data reported by the Senior Medicare Patrol Projects. In addition, we requested and reviewed documentation from the projects for the funds recovered to the Medicare program, the Medicaid program, beneficiaries, and others that were attributable to the projects. We also requested and reviewed documentation for the measure of cost avoidance. We did not review documentation for the other performance measures.

WHAT WE FOUND

In 2011, the 54 Senior Medicare Patrol Projects had 5,671 active volunteers, a 14-percent increase from 2010. These volunteers conducted 66,303 one-on-one counseling sessions and 11,109 group education sessions. In 2011, 431,128 beneficiaries attended group education sessions, an increase from 298,097 in 2010. At the same time, Medicare funds recovered that were attributable to the projects were $19,283 in 2011. Total savings to Medicare, Medicaid, beneficiaries, and others were $32,941. Additionally, cost avoidance on behalf of the Medicare program, the Medicaid program, beneficiaries, and others, totaled $247,850. One of the projects, however, reported referring two large-dollar cases to a Medicare contractor. In one of these cases, the Medicare contractor is seeking to recover $2.9 million in overpayments from a provider who was identified by the project.

We continue to emphasize that the number of beneficiaries who have learned from the Senior Medicare Patrol Projects to detect fraud, waste, and abuse and who subsequently refer cases to Medicare contractors or law enforcement entities cannot be always be tracked. Therefore, the projects may not be receiving full credit for savings attributable to their work. In addition, the projects are unable to track substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries' scrutiny of their bills.

This report does not contain recommendations.

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