Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 26, 2009 PDF

Seniors volunteer for this program, which aims to help the OIG detect issues that might constitute fraudulent billing or coding trends.

The government recruits different types of people to check for Medicare fraud, but not all of those recruits are attorneys or federal employees. In fact, some of them might be your very own Medicare patients, who are eligible to join the Senior Medicare Patrol, a group of over 4,600 volunteers who are trained to detect fraud, waste, and abuse in the Medicare system.

The Senior Medicare Patrol (SMP) has been in business since 1997, and during that 12-year period, its members have recovered over $4.5 million for Medicare. In addition, the SMP has been responsible for over $100 million total in savings to the government via Medicare, Medicaid, Social Security, and other programs attributable to the SMP, according to a May 18, 2009 OIG report entitled "Performance Data for the Senior Medicare Patrol Projects."

According to the SMP Program's Web page, it teaches its volunteers to watch for fraud and abuse, such as upcoding, unnecessary test referrals, and billing for services that weren't provided.

The program also advises seniors of Medicare and Medicaid scams that  they might encounter and offers information on how to identify and report any such scams.

Upon learning of the SMP's intentions, some medical practices have expressed concern that they are being audited even when they are not aware of it. But the program isn't designed to turn Medicare patients into undercover detectives, experts say.

"The Senior Medicare Patrol is an education-based program showing Medicare beneficiaries and their families how to watch for Medicare fraud," Julie Schoen, Esq., director of California's SMP program, tells Part B Insider.

"We tell patients that if they are billed for a service they didn't receive, they should question that. We're not telling the volunteers to go out after providers, but instead we tell them, 'If you see something going on, report it,'" Schoen says.

If the SMP administrators see a pattern among the volunteers' reports and find complaints about a particular provider, they determine whether they've found a trend which might result in them looking at a provider more closely.

For example: "We're currently investigating a complaint regarding a provider who is billing the 75-minute personal counseling session for every patient he sees," Schoen says. "That is the type of case that would make us want to investigate further."