Senior Medicare Patrols (“SMP”) provide free assistance to Medicare beneficiaries, their families, and caregivers to prevent, detect, and report Medicare fraud. SMP’s are funded with grants from the U.S. Department of Health and Human Services, U.S. Administration for Community Living. There is an SMP office in each of the 50 states, Washington, D.C., Puerto Rico, Guam, and the U.S. Virgin Islands.
SMP conducts educational outreach programs for Medicare beneficiaries, engages volunteers who work directly with Medicare beneficiaries, and reviews complaints from Medicare beneficiaries. SMP refers any cases of suspected fraud or abuse to state and/or federal agencies for investigation.
One of the things SMP strives to educate Medicare beneficiaries and their caregivers about is how to review Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs) to identify inaccuracies, which may be indicators of fraud. MSNs and EOBs show the services the health care provider billed Medicare for, the amount paid by Medicare, and the amount of any co-payment due from the beneficiary. An SMP video tutorial explaining the basics of how to read MSNs can be found here.
SMP encourages Medicare beneficiaries to keep a written record of all medical services, tests, and equipment they receive, along with receipts for any co-payments they paid. Local SMP offices provide Personal Health Care Journals that are useful to record this information.
A comparison of the MSNs and EOBs to the beneficiaries’ own written record of his/her doctor visits, tests, services, and medical equipment received should reveal any inconsistencies, such as services the provider billed for but never provided to the patient, duplicate billing for the same service, or reflecting that a co-payment was paid when the patient was never asked to make a co-payment.
Inconsistencies should be brought to the attention of the health care provider so that errors can be ruled out. Beneficiaries not satisfied with the provider’s response, however, or who are uncomfortable contacting the provider directly, should contact their local SMP office for help. SMP can then assist in determining if it was an error or possibly healthcare fraud. If SMP suspects that it may be fraud, SMP will refer it to the appropriate agency for investigation – the Centers for Medicare and Medicaid Services, State Medicaid Fraud Control Unit, local law enforcement, the state attorney general, or others.
Medicare beneficiaries and their caregivers can reach the SMP by calling its nationwide toll-free number: (877) 808-2468 or by clicking here to use the online Locator to locate their closest SMP office.