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HHS OIG — Performance Data for the Senior Medicare Patrol Projects: June 2014 Performance Report

June 26, 2014

Performance Data for the Senior Medicare Patrol Projects: June 2014 Performance Report
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
This memorandum report presents performance data for the Senior Medicare Patrol (SMP) projects, which receive grants from the Administration for Community Living (ACL) to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of health care fraud. (ACL was established in 2012, bringing together the Administration on Aging (AoA) and two other offices.) In July 2010, AoA requested that OIG continue to collect and report performance data for the projects to support its efforts to evaluate and improve their performance. OIG currently reports this performance data on an annual basis.

HOW WE DID THIS STUDY
We based this review on data reported by the SMP projects. In addition, we requested and reviewed documentation from the projects for expected recoveries of funds for the Medicare and Medicaid programs. We also requested and reviewed documentation for actual savings to beneficiaries and others that were attributable to the projects, as well as for cost avoidance. We did not review documentation for the other performance measures.

WHAT WE FOUND
In 2013, the 54 SMP projects had 5,406 active volunteers, a 5-percent increase from 2012. These volunteers conducted 148,235 one-on-one counseling sessions, a 31-percent increase from 2012. They also conducted 14,924 group education sessions in 2013, compared to 14,748 in 2012.

In 2013, expected Medicare and Medicaid recoveries that were attributable to the projects were 9.1 million, a 50-percent increase from 2012. However, total savings to beneficiaries and others decreased from $133,971 in 2012 to $41,718 in 2013. Finally, cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others increased by 26 percent, from $113,692 in 2012 to $143,282 in 2013.

We continue to emphasize that 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. Therefore, the projects may not be receiving full credit for savings attributable to their work. In addition, the projects are unable to track the substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries’ scrutiny of their bills.
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