Senior Medicare Fraud Patrol Recovers $5.9M

Cheryl Clark, for HealthLeaders Media , June 24, 2014

A California beneficiary trained to spot fraud saw something on her Medicare summary notice and said something to her local fraud patrol organization, sparking a multi-year federal investigation and ending in jail time for fraudsters.

In a typical year, the national Senior Medicare Fraud Patrol (SMP), a federal program that helps beneficiaries identify scams, doesn't recover much money. The average annual collection between 2008 and 2012 was a mere $1.2 million.

But a recent Office of Inspector General report tallying results for 2013 showed that the total for 2013 was $9.04 million, virtually all of which—$8.9 million—came from the California SMP program, run by California Health Advocates (CHA), a non-profit in Santa Ana.

Nearly $5.9 million came from one case in which fraudulent activities targeted Southern California's large Vietnamese community.

Organized by a CHA staffer who speaks Vietnamese, the $5.9 million case was the result of multiple media messages, educational classes, and other events specifically focused on Vietnamese beneficiaries, because they are frequently the targets of a type of scam called 'affinity fraud.'

'It happens a lot, when [providers] take advantage of their own people,' says Micki Nozaki, an SMP data specialist with the CHA authorized to speak about the case, but not directly involved in it. 'You have an affinity or a trust relationship with this individual and you think they're going to be ethical and honest.'

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