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Medical Coding News Archives

Expansion of the Senior Medicare Patrol Program Is Proposed

July 3, 2013:

Regina Magnani, RHIT, Clinical/Technical Editor

The Department of Health and Human Services recently announced a proposed rule that would increase rewards paid to Medicare beneficiaries and other individuals whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million.

The Senior Medicare Patrol (SMP) is a national, volunteer-based program that uses Medicare beneficiaries and other individuals to prevent and report Medicare fraud, waste, and abuse. Since 1997, more than 3.5 million beneficiaries have learned how to recognize and fight fraud and abuse, and more than 7,000 referrals have been made to Medicare investigators.

A recent new funding opportunity supports the expansion of SMP activities to educate Medicare beneficiaries on how to prevent, detect, and report Medicare fraud, waste, and abuse. Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program.

Over the last three years, more than $14.9 billion in fraud has been recovered. Some of this has resulted from fraud reporting by individuals, which HHS has found to be a proven tool for the government to detect fraud, waste, and abuse in the Medicare program. Under the proposed changes, a person who provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered up to $10 million. HHS currently offers a reward of 10 percent up to $1,000 under the incentive reward program. The changes are modeled on an IRS fraud program that has returned $2 billion since 2003.

These proposed changes will support the administration’s comprehensive approach to program integrity. The Health Care Fraud Prevention and Enforcement Action Team, a joint effort by HHS and the Department of Justice to fight health care fraud, recovered more than $4.2 billion in taxpayer dollars in fiscal year 2012.


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