2017 Performance Data for the Senior Medicare Patrol Projects

WHY WE DID THIS STUDY

This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from ACL to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. OIG has collected these performance data since 1997.

HOW WE DID THIS STUDY

We based our review on data reported by 53 SMP projects for 7 performance measures pertaining to recoveries, savings, and cost avoidance and 5 performance measures relating to SMP activities. For the first group of measures, we reviewed supporting documentation for the data. For the second group, we reviewed the data for any discrepancies (e.g., if a project reported holding no events but reported a number of people attending events).

WHAT WE FOUND

In 2017, the 53 SMP projects had a total of 6,130 active team members who conducted a total of 26,429 group outreach and education events, reaching an estimated 1.9 million people. In addition, the projects had 226,261 individual interactions with, or on behalf of, a Medicare beneficiary.

For 2017, expected Medicare recoveries totaled $2,010,475, which came primarily from one project that prompted law enforcement to open an investigation that resulted in a settlement with a hospice company. The SMP projects also reported $211,749 in cost avoidance and $44,468 in savings to beneficiaries and others.

In comparison to 2016, the projects reported having reached more people through group outreach and education events (1.9 million, up from 1.5 million) and reported having had more individual interactions (226,261, up from 195,386). The number of total active team members and the number of group outreach and education events remained fairly constant between the 2 years. In addition, the projects reported significantly higher amounts for expected Medicare recoveries ($2 million, up from $2,672) and slightly higher amounts for cost avoidance ($211,749, up from $163,904). However, the projects also reported slightly lower savings to beneficiaries and others ($44,648, down from $53,449). The projects reported no expected Medicaid recoveries in either year.

We note that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work. It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries' scrutiny of their bills reduces fraud and errors.