If Angela Lansbury should reprise her role as television's senior sleuth Jessica Fletcher, HHS has just the script for her, and it's even paying to train understudies.
The department recently awarded almost $2 million to recruit and train volunteer ranks of retired professionals to help the government uncover fraud, waste and abuse in Medicare and Medicaid.
"It'll help serve notice to outright crooks that we're turning seniors loose on abuse," said Bill Benson, acting head of HHS' Administration on Aging.
A dozen projects around the country were awarded the grant money, which will pay for the first year of a two-year demonstration project. It will be up to Congress to set aside more money to keep the program going.
"We're pretty confident we'll get a second year's funding out of it," Benson said.
The grants are yet another way the government is turning up the heat on people who rip off federal insurance programs for the poor and the elderly.
A recently released report from HHS' inspector general's office estimated that as much as 14% of Medicare claims, or $23.2 billion, were overpaid last fiscal year because of improper fee-for-service Medicare billings (July 21, p. 13).
What the demonstration program does is put people on the front lines to spot some of these billing problems.
The idea is to train volunteers, such as retired doctors, lawyers, accountants and teachers, to unravel the complexities of the Medicare and Medicaid systems. That way, they can work with people in their communities to help them understand their benefits and look for problems such as overbilling and unnecessary services.
The hope is that the volunteers will help beneficiaries become more attuned to their bills.
"People don't pay attention, particularly if they don't have to pay," said Michelle Holzer of the Maryland Office on Aging, which was awarded a $180,000 grant. Holzer is program officer for the senior Health Insurance Counseling and Advocacy program.
But the Medicare explanation of benefits can be "overwhelming" for some seniors, said Donna Harvey, executive director of the Hawkeye Valley Area Agency on Aging in Waterloo, Iowa, which will share in a $186,743 grant.
"(Seniors) just take (the bills) and think that must be it and not want to expend the effort and go back and question some of those charges or even know where to start to question those charges," Harvey said.
Agencies such as Harvey's and Holzer's said training volunteers to master such heady stuff won't be a problem.
Since word got out that the Heritage Area Agency on Aging in Cedar Rapids, Iowa, was getting some of the grant money, Director Tom Miskimen has gotten lots of calls from people who want to volunteer for the "fraud patrol." Ultimately, it could total 100 or more people, he said.
Miskimen said the volunteers will be like a dose of preventive medicine, putting providers on notice to beware of questionable practices.
"A lot of people are going to be looking," Miskimen said.
Besides training volunteers, the demonstration projects also will include World Wide Web sites and toll-free hotlines.
The demonstration program was created with the help of Sen. Tom Harkin (D-Iowa), who has had a longstanding interest in combating the problem of fraud and abuse, Benson said. It complements other government anti-fraud measures, such as Operation Restore Trust.
HHS launched Operation Restore Trust in May 1995. It recently was expanded beyond the program's original parameters of home-care providers in five states.
Holzer said not all seniors will want to report billing problems, especially if they benefit from a service they're not entitled to under Medicare or Medicaid payments rules.
In California, 500 volunteers are already at work in 24 Health Insurance Counseling and Advocacy Programs to help seniors in community centers and Social Security offices navigate the Medicare maze, said Julie Schoen, an attorney with one of the programs. The new $188,000 grant means recruiting more volunteers to the cause.