Senior Medicare Patrol Projects Saved $12M in 2018

The SMP projects cost the government more than they saved in 2018, but OIG said the savings could be understated.

The nation's 61 Senior Medicare Patrol projects played a role in saving Medicare more than $12 million in 2018, according to a report from the Department of Health and Human Services Office of the Inspector General.

The bulk of the savings came from expected recoveries of $11.9 million from the SMP's role in identifying two home health fraud schemes and one physician who provided unnecessary services and falsified records, OIG said.

The 6,935 members of the 61 SMPs in 2018 also reported $15,136 in Medicare recoveries, $5,734 in Medicaid recoveries, generated cost avoidance of $602,063, and saved beneficiaries and others $27,689, OIG said.

The Senior Medicare Patrol program was created in under the 1997 Omnibus Consolidation Appropriation Act, and is funded by grants from the U.S. Administration for Community Living.

The 61 SMPs conducted a total of 26,932 outreach events, reaching 1.7 million people, with 278,761 interactions with individual Medicare beneficiaries or their caregivers, OIG said.

The SMPs showed a 23% increase from 2017 with individual interactions in 2018 (278,761, up from 226,261). In addition, the projects reported significantly higher amounts for cost avoidance ($602,063 in 2018, up from $211,749 in 2017), while expected Medicare recoveries dropped ($15,136, down from $2 million). The number of beneficiaries contacted through outreach efforts declined to 1.7 million in 2018 from 1.9 million in 2018, OIG said.

With an operating budget of $18.1 million in 2018, the SMP projects appeared to cost the government more than they saved, but OIG said the savings it's audit found could be understated.

"We note that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work," OIG said. "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," OIG said.