Senior Medicare Patrol works to prevent Medicare fraud

It is considered one of the government's least sophisticated measures against Medicare fraud, but is boasting some big successes.

The Senior Medicare Patrol is sponsored by the Administration on Aging, and is made up of volunteers who work with medicare and medicaid recipients to help protect against fraud.

Shirley Merner works with the Senior Medicare Patrol in Iowa and said their mission is pretty straightforward.

"The basic message is to protect, detect and report. It's a simple, three-pronged message. We want [people] to learn how to protect their identity because Medicare medical identity theft is the fastest growing crime in the United States currently. We need them to know how to detect errors, fraud, waste and abuse within the system by reading their Medicare summary notices. Then, they need to know [how] to report any discrepancies they find in the system."

Thus, the program is very proactive and educational.

Merner said it is difficult to estimate how many people make up the Patrol mainly because the workforce is volunteer-based.

"We have a program in every state, so every state has at least one paid staff person. They may have more. They may not. They're charged to recruit and train volunteers. Currently we have about 4,700 active volunteers. . . . Here at our Iowa SMP program we have lots of snowbirds who are inactive currently. . . . When you're dealing with seniors and the older population as your volunteer base, they're somewhat transient. So, the number varies."

Though the number of volunteers might swell and wan, Merner said waste, fraud and abuse in dollar amounts is on the up and up.

To date, the SMP has caught over $100 million in fraud since 1997, a figure that she credited mostly to an increasingly educated populace.

"It's basically because people have read their Medicare summary notices and report things that have happened, either overbilling, underbilling, getting billed for products they did not receive. Of course, these are just the ones we can document."

The purposed of the SMP is not to play 'gotcha' with the medical billing or drug companies, either. The group simply wants to better educate seniors to eliminate errors.

"We know that, truly, the providers of medical services across the United States -- 99 percent of them are honest and they truly care about their patients and their health and their healthcare. It's that one percent that we're really concerned about, and that one percent is getting $1 out of every $10 that's budgeted for Medicare per year."

According to the most recent report from Medicare's Inspector General, $60 billion was somehow wasted last year.

To reduce that number, Merner said her group is pushing not only for recipient education, but for provider education, as well.

"Providers need to know how to protect their identities. We're finding many, many providers that are having their provider numbers stolen or their name being misused and forged on prescriptions."

In addition, SMP works with law enforcement officials, as well.

Overall, Merner said her hope is to get everyone involved with Medicare to become more active in the hopes of reducing the dollar amount associated with waste, fraud and abuse.

"$60 billion would pay the salaries of 1.7 million American workers for one year. It would pay the healthcare of two out of three people over the age of 65 for one year. It would pay for one third of the prescription drugs now bought in the United States for one year. It's huge -- and it's impact is huge."

If you're interested in learning more about SMP -- or getting involved yourself -- Merner said to check out their Web site.