WASHINGTON -- As government officials continue to target Medicare fraud, they've doubled the funding for senior-citizen volunteers who do everything from explaining benefits to sending tips to investigators. One tip led to a piece of this month's record-breaking Medicare fraud takedown
Officials believe that if older Americans—including the growing crop of eligible Baby Boomers — know how to spot errors and fraud, "more criminals will be put in jail where they belong," Barbara Dieker told a group of volunteers recently. Dieker directs the Department of Health and Human Services' Office of Elder Rights, which oversees the Senior Medicare Patrols (SMPs).
Funding for the Senior Medicare Patrols increased from $9million last year to $18 million this year in the form of Administration on Aging grants that target fraud-rich regions, including Florida, California, New York and Michigan.
The patrols spend most of their time answering questions and educating Medicare beneficiaries, which, according to the Centers for Medicare & Medicaid Service's (CMS) inspector general, makes it difficult to measure just how effective they are. In fact, money brought in by the SMPs dropped 82% in 2010 to $22,262, from $214,060 in cost avoidance in 2009, according to the inspector general.
"The projects may not be receiving full credit for savings attributable for their work," the inspector general's report states.
Since the program began in 1997, Dieker said, the senior volunteers have educated 9.2 million people about Medicare fraud, received 87,000 complaints from beneficiaries, and saved Medicare and Medicaid $105.9 million.
Coordinators from across the country say their volunteers' tips have led Justice Department investigators to national trends that don't necessarily reflect back on the patrols.
"Just because you refer a case, doesn't mean you get credit," said Alice Ierley, SMP coordinator in Colorado. At a national training session last spring, "the feedback from the feds was that they can't feed the case data back to us; it's not their priority, nor should it be."
Colorado just received recognition for referring the highest number of Medicare fraud cases — 87 — for investigation, as well as referring the largest amount of money for further action — $156,000. The state received a $100,000 grant.
The cases Ierley sees most often include medical equipment, such as wheelchairs, and scams involving insulin shots for diabetics. Those little cases tend to get rolled into big national investigations.
"The cases we're working are getting referred as complex cases," said Ed Mendicello, Colorado case investigator. "It's no longer $500 here and $1,000 there; it's part of a pattern."
Dieker said there's no way to trace money saved by prevention. In one case, a Colorado woman complained that a company tried to sell her insurance based on the federal health care law, falsely explaining that she needed to pay $349 to get benefits in addition to Medicare. She didn't pay, but she did write down the phone number. Investigators later tracked the number to a marketing mill.
"There was no money involved because she didn't pay it, but the FBI's involved now," Mendicello said. "It turned out the owners have a background in extortion back to the 1990s."
California received a $430,000 grant — the largest amount given out to any state. Volunteers there often work with underserved and non-English speaking communities. Their tips have also led into national investigations. In one case, the volunteers were educating people at a Vietnamese housing facility when a woman said, "I have a wheelchair I don't need."
"CMS interviewed 30 people in this facility who wanted to give their chairs back when they found out they shouldn't have had them," said Julie Schoen, who heads up California's Senior Medicare Patrol program.
Even as the amount of money reported back from the SMPs has gone down, Schoen said they're getting more phone calls from "savvier consumers."
"Our relationship with CMS is getting better," she said. "They hold us as a partner. And the (inspector general) has gotten so much more involved with us — they realize it's hard to track savings."
The Florida SMP, which also received a $430,000 grant, focuses its attention on education. During the first week of September, they were pulled into Medicare fraud's largest takedown in history.
In 2009, at a low-income housing complex for seniors, one of the residents was being paid kickbacks to send other residents to mental health counseling.
"Basically, it was social hour," said Makeba Huntington, SMP coordinator for Florida. "They sat around and ate ice cream."
A resident called the SMP hotline, she said. Huntington's office eventually learned it was part of a much larger case.