Performance Data for the Senior Medicare Patrol Projects: July 2015 Performance Report

Updated Report

This report was originally issued on July 29, 2015. OIG discovered that the data for the total number of volunteer training hours, pulled from ACL's system, was incorrect. On August 21, 2015, we reissued the report with revised figures provided by the program - please use this version. The earlier report stated that the total number of volunteer training hours was 15,189 - the updated figure is 39,196. We also revised the other performance measures so that they would be based on data pulled at the same point in time as the updated training measure. For the other measures, the revised figures differ slightly from the original, with most differences ranging from 0.1 percent to 1.0 percent. The expected recoveries and savings remain the same. Please also note that ACL is transitioning to a new data system as of September 2015.

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. In July 2010, the Administration on Aging (AoA)-now part of ACL-requested that OIG continue to collect and report these data to support AoA's efforts to evaluate and improve the SMP projects' performance. (ACL was established in 2012, bringing together AoA and two other offices.) OIG currently reports the SMP projects' performance data on an annual basis.

HOW WE DID THIS STUDY

We based this review on data reported by 53 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 savings to beneficiaries and others that were attributable to the projects, as well as documentation for cost avoidance. We did not review documentation for the other performance measures.

WHAT WE FOUND

In 2014, the 53 SMP projects had a total of 5,294 active volunteers. These volunteers conducted 202,862 one-on-one counseling sessions. They also conducted 14,692 group education sessions, which were attended by a total of 452,714 beneficiaries. The projects reported conducting 110,615 media airings (i.e., any distribution of media-print, radio, television, electronic) to educate about fraud and the services of the project. Additionally, the projects reported conducting 12,417 community outreach education events. As a result of these sessions and events, the projects received 92,754 simple inquiries and resolved 91,181 of them. They also received 1,614 inquiries involving complex issues, of which 660 inquiries were referred for further action.

In 2014, expected Medicare and Medicaid recoveries that were attributable to the projects were $661,333. Savings to beneficiaries and others totaled $80,228, and cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others was $200,598.

We continue to emphasize that the projects may not be receiving full credit for savings 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 substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries' scrutiny of their bills.