Wednesday, December 30, 2009


I've posted several times on Medicare/Medicaid fraud, most recently in October. Billions of dollars have been drained from these programs by unscrupulous providers, among them medical equipment providers. Too often the Justice Department is too busy with other, "more important" crimes to investigate and prosecute this fraud, but it is more willing to go forward on cases which have been put together for them. Now the DOJ and the Centers for Medicare and Medicaid Services (CMS) have some help, according to an AP report.

Staffed by elder volunteers, the Senior Medicare Patrol uses a two-pronged approach to identifying Medicare fraud.

SMP sends its volunteers to senior centers, retirement communities and elsewhere to encourage Medicare beneficiaries to guard their personal information, beware of too-good-to-be-true offers on medical equipment and carefully review their benefit statements. The patrol also collects tips on potential scams and fields calls from senior citizens who believe their Medicare accounts have been fraudulently billed.

When all they have is a whiff of something fishy, SMP participants often keep probing until they have enough information to send on to the FBI and investigators with the Centers for Medicare and Medicaid Services.

The education of elders on the issue is key. Too many elders don't realize how important their Medicare account number is, especially when combined with their social security number, date of birth, and home address. According to the AP article, an entire "phishing" industry has evolved in which an offer of free transportation to medical appointments yields that vital data, which is then sold to the next stage of scammers.

A careful review of each Medicare benefit statement would alert the elders whenever a piece of equipment or expensive medical test never received is charged. That's when the Senior Medicare Patrol steps in. The volunteers does a little probing and investigating and when there is some hard information, they turn the case over to the FBI and CMS.

The program has been successful, given the limited number of volunteers it has at this point (4,700 in the nation, with an chapter in each state). It has saved the taxpayers more than $100 million since 1997, and that could rise with a little encouragement and some funding to expand the outreach. Not a bad record for a bunch of retirees, eh?

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