2018 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 older adults and community members 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 61 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 that attended events).

WHAT WE FOUND

In 2018, the 61 SMP projects had a total of 6,935 total active team members who conducted a total of 26,932 group outreach and education events, reaching an estimated 1.7 million people. In addition, the projects had 278,761 individual interactions with, or on behalf of, a Medicare beneficiary.

For 2018, the SMP projects reported $15,136 in expected Medicare recoveries and $5,734 in expected Medicaid recoveries. Cost avoidance totaled $602,063, while savings to beneficiaries and others totaled $27,689. Further, additional Medicare expected recoveries totaled $11.9 million. These recoveries came from three projects that validated information for existing cases regarding two home health fraud schemes and one individual physician who provided unnecessary services and falsified records.

In comparison to 2017, the projects reported a 23-percent increase in the number of individual interactions in 2018 (278,761, up from 226,261). Although the number of group outreach and education events remained fairly constant between the 2 years, the projects experienced a decrease in the number of people reached through these channels (1.7 million, down from 1.9 million). In addition, the projects reported significantly higher amounts for cost avoidance ($602,063, up from $211,749), while expected Medicare recoveries dropped ($15,136, down from $2 million).

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.