2019 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 54 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 who attended events).

WHAT WE FOUND

In 2019, the 54 SMP projects had a total of 6,875 active team members who conducted a total of 28,146 group outreach and education events, reaching an estimated 1.6 million people. In addition, the projects had 320,590 individual interactions with, or on behalf of, a Medicare beneficiary.

For 2019, the SMP projects reported $2.4 million in expected Medicare recoveries. Almost all of these recoveries came from one project that uncovered a fraud scheme that encouraged low-income senior citizens to submit DNA samples for medically unnecessary genetic testing. Three defendants were sentenced and ordered to pay a total of $2.3 million in restitution and forfeitures. In addition, cost avoidance totaled $60,971, while savings to beneficiaries and others totaled $20,150.

In comparison to 2018, the projects reported a 15-percent increase in the number of individual interactions in 2019 (320,590, up from 278,761). The number of group outreach and education events increased slightly by 5 percent, but the number of people reached through these channels decreased by about the same percentage (1.6 million, down from 1.7 million). In addition, the projects reported significantly higher amounts for Medicare recoveries ($2.4 million, up from $15,136), while cost avoidance dropped ($60,971, down from $602,063).

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.