Seniors Volunteer to Find and Prevent Medicare Fraud

Sept. 25, 2011 -- A dozen senior citizens sat around a table here recently, drinking coffee and shaking their heads.

"There was a doctor in Florida arrested for saying he needed to remove something he had already removed," Leonard Washington said. "They get more time for doing drugs than they do for Medicare fraud."

His complaint started a flurry of tsk-tsking: kickbacks to active seniors who say they need help with insulin shots, unknown callers who claim they need Medicare beneficiary numbers to offer more care, and elderly people intimidated into unnecessary medical tests.

These seniors represent a few of the 68,000 volunteers who have been trained since 1997 as part of Senior Medicare Patrols (SMPs). They spend their spare time educating other seniors about Medicare, mediating billing questions between doctors and patients, and sleuthing out fraud to forward to investigators.

It's the fraud that makes them angriest — $60 billion a year, they learn.

"I want people to stop what they're doing," said Josefa Campos, explaining why she volunteered. "It's not right."

In the training session, they learned that organized crime has moved toward Medicare fraud because it's safer than dealing drugs and guns; they've heard that criminals have taken advantage of the confusion over the federal health care law to target seniors; and they know that as many more people enter the senior-citizen ranks, more people will be at risk for fraud.

In an effort to fight Medicare fraud, the federal government has doubled its funding for the SMP program in the hopes of training more volunteers.

"The more people who are out there, the more we can tell, 'This is happening to us,'" said Theresa Brownson, who heads up Washington's Senior Medicare Patrol.

The more experienced patrol members offered advice to the new volunteers: Make eye contact. If someone's not paying attention during a training session, stand next to him. Be on time and don't interrupt lunch.

They tell their seniors to get keep copies of all their medications and all of their doctors' phone numbers, and to read their Medicare statements, even when it says, "This is not a bill."

"I used to think, 'Well, great; I don't have to read it,'" said Christine Tolson, laughing. "Now I'm a community activist; I just care about taxpayer dollars."

Beyond the training sessions at community centers and churches, the volunteers often find that their tips strike closer - or even at - home. Medicare conversations start over fresh vegetables at the grocery store or with coffee after a morning walk.

"I get questions from my family," said Emma Beshir, who said she received a letter inviting her to volunteer. "'What is this? I don't understand that.' It's important because it saves my Medicare."

The volunteers leave the session armed with PowerPoint presentations, warnings against off-color jokes or political statements, and a sense of pride that they can help seniors fight fraud.

"You see someone after a training session, and they say, 'I took care of it,' and you see the expression on their face," LaVerne Scott said. "It's so rewarding."