HHS says grassroots efforts to fight Medicare fraud have paid off

A program to educate seniors about fraud in government-run health programs has saved taxpayers $100 million during the last 12 years, according to the Health and Human Services Department.

HHS reviews of the SMP (formerly Senior Medicare Patrol) Projects, including self-reported information on funds recovered to Medicare and Medicaid programs, turned up the savings. The Administration on Aging, an agency within HHS, runs the program, which relies on volunteers.

"The strongest defense against crime is not law enforcement, it is informed citizens," said HHS Secretary Kathleen Sebelius, at an AoA-sponsored conference in Washington on Tuesday during a keynote address to program volunteer coordinators and trainers.

"[SMP] is empowering seniors at the grassroots level to prevent healthcare fraud," said Kathy Greenlee, assistant secretary for aging, at the event.

Volunteers, most of whom are retirees on Medicare and are well-positioned to assist their peers, staff the 54 nationwide SMP Projects. They teach Medicare and Medicaid recipients how to protect personal information, identify and report billing errors, and recognize illegal marketing and unnecessary services. Since its creation in 1997, SMP has educated 20 million citizens about Medicare fraud. The $100 million in government savings applies to both Medicare and Medicaid programs.

The government is on track to spend $425 billion on Medicare and $200 billion on Medicaid this year alone. The Centers for Medicare and Medicaid Services pay 3 million claims to 1.5 million different suppliers and providers daily. The challenge, Sebelius said, is to ensure that claims payments are processed quickly, efficiently and legitimately.

"It's definitely a team effort," she said, noting that the Justice Department, AoA, CMS and the Office of the Inspector General are working with HHS to reduce Medicare fraud. "As any good team, we recognize that everybody has a part to play."

In response to the Obama administration's request for better cross-agency cooperation on the issue, Sebelius and Attorney General Eric Holder in May introduced the Healthcare Fraud and Prevention Enforcement Action Teams, made up of senior officials from both departments. These teams help monitor and analyze healthcare provider activities, and already have halted a $16 million fraud scheme in Houston. Additional enforcement groups operate in Miami, Detroit and Los Angeles.

"We're prepared to expand [strike] teams wherever fraud may take us," said Sebelius on Tuesday. "We're trying to get out ahead of fraudulent activity…and we're willing to spend the resources to do it."

HHS and Justice also are developing more expedient data analysis methods to share real-time information on waste and fraud, and will continue to support SMP efforts. Fighting fraud, said Sebelius, is one of the best investments the government can make.

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