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Helping to Stop Health Care Fraud

Health care fraud, waste, and abuse cost American taxpayers nearly $60 billion each year. Medicare and Medicaid consumers are an essential element in national fraud fighting efforts. Consumers are best positioned to detect and report abuse and the Senior Medicare Patrol (SMP) aims to empower them to do so through education and advocacy. The Area Agency on Aging hosts the regional SMP to help with this effort in Southern Illinois.  The goal of the SMP Program is to train seniors to recognize and report fraud. 

The national Senior Medicare Patrol program is working to strengthen Medicare by using these regional offices to recruit and train retired professionals and other senior citizens to recognize and report both health care billing errors and suspected instances of health care fraud. Each year nearly 4,500 volunteers, trained by regional SMP offices conduct community outreach and peer-to-peer training to help Medicare consumers:

             • Identify potential scams and other fraudulent activity

                • Protect their personal information including Medicare and Social Security numbers     

                • Detect errors on their Medicare Summary Notices (MSNs) or Explanations of Benefits 

            • Report suspected fraud or abuse to the proper authorities

One might wonder if fraud happens locally.  It does happen.  Recently, a local provider was sentenced to prison for fraudulent billing and money laundering and was sentenced to five years and 10 months in federal prison and three years’ probation after pleading guilty to 14 counts of health care fraud and one count of money laundering.  The provider admitted to keeping almost no records and creating fake documents to bill 14 companies or health insurance funds more than $2 million since 2006.  This provider must pay the money back and forfeit more than $900,000 in cash and property, two minivans and a BMW.  This is just one incident.  Imagine the taxpayer dollars that that can be saved by eliminating all cases of fraud. 

The Affordable Care Act of 2010 provides a number of new tools and resources to prevent fraud and strengthen Medicare. The law improves analysis of health care claims data to flag potential scams, strengthens the screening process for health care providers that wish to participate in Medicare and Medicaid, and provides increased penalties for those committing fraud. These new fraud-fighting tools will help the government identify false claims faster, prosecute health care fraud more effectively, and help prevent fraud from occurring in the first place.  If you suspect fraud contact the Area Agency on Aging at 1-800-326-3221.

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