Anti-fraud training for seniors shows mixed results

Stepped-up federal funding resulted in more seniors receiving training in how to stop Medicare fraud in 2012, but the latest annual survey of the $20 million program shows it produced $134,000 in actual savings.

Many illegal schemes rely on seniors who aren't savvy in how fraudsters and opportunists can use Medicare numbers to bill for care and equipment that is unneeded or never delivered. The Obama administration greatly increased the funding in 2010, 2011 and 2012 to bolster the so-called Senior Medicare Patrol program, which educates them with a branch in each U.S. state, plus Washington, D.C. and three territories.

Results have been mixed. Program officials boosted the number of seniors trained in individual sessions by 71% in 2012, and by 33% in group settings, even though the number of active volunteers in the program fell by almost 10%, according to an annual review of the program by the HHS' inspector general's office that was published Monday (PDF).

In terms of results, the program posted $134,000 in funds that were recovered in 2012 by Medicare, Medicaid and beneficiaries after seniors learned of suspicious activity. That's compared with just $33,000 the year before (PDF).

In 2012, the OIG modified its definition of recoveries to include money that was “expected” to be returned to the CMS but had not yet been collected. By that measure, Medicare and Medicaid expected savings were estimated at $6 million in 2012. (No prior-year data were available.)

The program gets roughly $10 million through the department that operates it, the U.S. Administration on Aging, plus budget boosts between $9 million and $10 million a year in 2010-12 from the Health Care Fraud and Abuse Control Program run by the Justice Department and HHS.

As in years past, the auditors suggested the numbers may understate the impact of the program because it's not possible to track all of the referrals from Medicare patrols that end up being used in the investigative and prosecution process. In one case, a project in the program provided information to prosecutors in a case that ended with a $12.9 million settlement with an unnamed company, the report says.

“In addition, the projects are unable to track the substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries' scrutiny of their bills,” the auditors wrote.

Follow Joe Carlson on Twitter: @MHJCarlson