AGING SERVICES: SMP Program - Senior Medicare Patrol

SMP Program - Senior Medicare Patrol

Donít Be A Victim of Health Care Fraud, Errors or Abuse!

Prevent, Detect & Report



What is SMP?

The mission of the SMP program is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling and education.

In Connecticut, SMP is operated by the State Unit on Aging in cooperation with the regional Area Agencies on Aging and the many volunteers who help power the program in our communities. SMP provides enhanced training on the issues of Medicare fraud and abuse to its network of volunteer and staff counselors. SMP counselors can provide education, assistance and advocacy to residents in order to identify, report and prevent Medicare fraud, waste and abuse.

The Senior Medicare Patrol (SMP) program is federally funded by the Administration for Community Living and is available across the countryAccording to the Office of Inspector General, in 2016 SMP Projects reported $217,353 in cost avoidance or savings on behalf of Medicare and Medicaid beneficiaries and others. Information provided from SMP projects to Federal prosecutors resulted in settlements totaling an additional $9.2 million in expected Medicare recoveries. Read more statistics.

What Does the SMP Program in Connecticut Do?

Through the recruitment and training of staff and volunteers the Senior Medicare Patrol provides the following services: 

  • One-on-one counseling and assistance to people on Medicare. Counselors are available to help beneficiaries read their Medicare summary notices, review their cases and understand billing and other paperwork. In suspicious cases, SMP can help beneficiaries to report fraud to the proper authorities. 
  • Presentations to beneficiaries, caregivers and other concerned citizens. Presentations cover the types of fraud and abuse that occur and the steps that seniors can take to protect themselves. To schedule a free speaker, call your local Area Agency on Aging at 1-800-994-9422 and ask to speak with someone from the Senior Medicare Patrol.

Check out volunteer opportunities with CT SMP.

Why should I care?   

Health care fraud is not just about the government. People can get sick, lose benefits, lose money and get stuck with bad equipment or other things they donít need. Remember, people who steal from Medicare and Medicaid are stealing from YOU. Consumers lose as much as $10 billion dollars a year and it is estimated that Medicare loses 60 billion annually. We want to ensure these programs will have money to operate and to provide good, quality health care for you and future generations. Although the majority of health care providers are honest, the activities of the remaining few result in wasted funds and a loss of quality of care for yourself and others.

What is Health Care Fraud?

Fraud occurs when an individual or organization deliberately deceives others in order to gain some sort of unauthorized benefit. Medicare fraud occurs when services provided to beneficiaries are deliberately misrepresented, resulting in unnecessary cost to the program, improper payments to providers, or overpayments. Medicare fraud generally involves billing for services that were never rendered or billing for a service at a higher rate than is actually justified.

Healthcare fraud is not just a matter of dollars and cents. Equally important is the serious effect on the quality of care received. For example, following a stroke a doctor prescribes physical therapy for a patient for an hour three times a week. However, the therapist regularly provides only ten minutes of therapy, but bills Medicare for the full hour each time. Not having the full amount of physical therapy could have led to a loss of function for the patient, which may never have been regained. Medicare beneficiaries can call the Senior Medicare Patrol to report such situations and insure receiving the full physical therapy benefit through another company.

Examples of health care fraud include:
  • Billing for services never performed or medical equipment or supplies not ordered
  • Billing for services or equipment that are different from what was provided or was returned 
  • DOUBLE BILLING - charging more than once for the same service
  • UPCODING - billing for a more expensive or covered item when a less expensive, non-covered item was provided. 
  • UNBUNDLING - billing related services separately to charge a higher amount than if they are combined and billed as one service or group of services.
  • Falsely claiming that services are medically necessary when they are not.
  • Using another personís Medicare card to get medical care, supplies, or equipment
  • Soliciting, offering or receiving bribes, rebates or kickbacks.  A kickback is an arrangement between two parties which involves an offer to pay for Medicare business.
What can I do?
Prevent, Detect and Report 

Prevent yourself from becoming a victim of health care fraud or scams:

Never give any personal information, such as your Medicare or Medicaid, Social Security, bank account or credit card numbers over the telephone or to people you do not know who come to the door or call you on the phone.

Never give your Medicare/Medicaid number in exchange for free medical equipment or any other free offer. Unscrupulous providers will use your numbers to get reimbursed for services they never delivered.  

DETECT possible instances of fraud:

Always keep a record of your health care appointments and the services.  Then review your explanation of Benefits (EOB) or Medicare summary notices (MSN) to ensure they properly reflect services that you received. The payment notice shows what services or supplies were billed to Medicare, what Medicare paid, and what you owe. Look for any charges that seem wrong to you Ė charges for something you didnít get, billing for the same thing twice, or services not ordered by your doctor.  If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct. Always inventory medical supplies and check against your statement. 

Be suspicious if a provider tells you that: 
  • The equipment, service or test is free.
  • The provider knows how to get Medicare to pay for items or services, even if they are not usually covered.
  • They claim to represent Medicare or maintains they have been endorsed by the federal government.
  • Use telemarketing and door-to-door selling as marketing tool.
  • Advertise "free" consultations to people on Medicare or offer ďfreeĒ testing or screening in exchange for your Medicare card number, just for their records.
  • Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests.
  • Charge co-payments on clinical laboratory tests, and on Medicare covered preventive services such as PAP smears, prostate specific antigen (PSA) tests, or flu and pneumonia shots.  

REPORT suspected instances of Medicare fraud, errors or abuse:

Here are some reporting steps:

  1. Call the healthcare provider or supplier first to question the charge. If it was a mistake, ask them to correct it.
  2. If the provider or supplier can't answer the question, call the company that paid the bill. Their contact information can be found on your Medicare Summary Notice or Explanation of Benefits.
  3. Call the Connecticut SMP at 1-800-994-9422 if the issue cannot be resolved or you suspect fraud or abuse. The Senior Medicare Patrol can assist you and can help refer cases to the proper authorities when necessary.

NOTE:  If you feel threatened by someone who is trying to steal your money or personal information Ė immediately call your local police or 911.

Resources for other types of fraud or identity theft:

Content Last Modified on 3/5/2018 8:41:46 AM