What is the SMP Program?
The SMP program, formerly known as Senior Medicare Patrol program or Idaho Medicare Education Partnership, help Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. In doing so, they not only protect older persons, they also help preserve the integrity of the Medicare and Medicaid programs. Because this work often requires face-to-face contact to be most effective, SMPs nationwide recruit and teach nearly 5,000 volunteers every year to help in this effort. Most SMP volunteers are both retired and Medicare beneficiaries and thus well-positioned to assist their peers.
SMP staff and their highly trained volunteers conduct outreach to Medicare beneficiaries in their communities through group presentations, exhibiting at community events, answering calls to the SMP help lines and one-on-one counseling. Their primary goal is to teach Medicare beneficiaries how to protect their personal identity, identify and report errors on their health care bills, and identify deceptive health care practices, such as illegal marketing, providing unnecessary or inappropriate services and charging for services that were never provided. In some cases, SMPs do more than educate: When Medicare and Medicaid beneficiaries are unable to act on their own behalf to address these problems, the SMPs work with family caregivers and others to address the problems, and if necessary, make referrals to outside organizations who are able to intervene.
It is possible to make a difference
SMPs are funded by the U.S. Administration on Aging (AoA). They receive technical assistance from the National Consumer Protection Technical Resource Center (The Center). Financial support from AoA and technical support from The Center are not enough to maintain the accomplishments of the SMPs. SMPs rely on the efforts of thousands of volunteers and hundreds of partnerships at the community, state and national levels. For more details about volunteer opportunities available within the SMP program, click here.
SMP activities support AoA’s goals of promoting increased choice and greater independence among older adults. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults -- thereby increasing their capacity to maintain security and independence in retirement and to make better financial and health care choices. For more information about the SMP program from AoA, click here.
History of The Program
In 1995, the Administration on Aging (AoA) became a partner in a government-led effort to fight fraud, error and abuse in the Medicare and Medicaid programs through the implementation of a ground-breaking demonstration project called Operation Restore Trust (ORT). ORT's purpose was to coordinate and target federal, state, local and private resources on those areas most plagued by abuse. Operation Restore Trust was announced at the 1995 White House Conference on Aging.
During its demonstration phase, ORT returned $23 for every $1 spent looking at the fastest growing areas of Medicare fraud, including home health care, skilled nursing facilities and providers of durable medical equipment. This comprehensive anti-fraud initiative created a partnership in the Department of Health and Human Services between the Centers for Medicare & Medicaid Services, the Office of Inspector General and the Administration on Aging, which continue to work as a team in a coordinated anti-health care fraud effort at the local, state and national levels.
AoA became a key player in the fight against fraud through the enactment of P.L. 104-209, the Omnibus Consolidated Appropriations Act of 1997. Language in this legislation, offered by Senator Tom Harkin (D-IA), was adopted, directing the AoA to establish demonstration projects that utilize the skills and expertise of retired professionals in identifying and reporting error, fraud and abuse.
Based on the success of the demonstration projects, the SMP program has grown to 54 projects, including every state and the District of Columbia, Puerto Rico, Guam and the Virgin Islands. Under Title IV of the Older Americans Act, approximately $10 million in grants were provided during FY 2005. Title IV funds continue to provide the funding for SMP projects today.
Idaho has been a part of this partnership since 1999 and today we have 130 volunteers statewide that work to help beneficiaries against fraud and abuse.
Stats
For up-to-date statistics regarding the effectiveness of the SMP programs, read the latest statistics compiled by the Office of the Inspector General, click here.
Donna Denney is ICOA's project director for the Idaho SMP Project. Call her at (208) 334-3833 if you have questions about SMP.
To get the help you need with Medicare and/or insurance problems and questions, or to receive training to be an SMP volunteer in your community, contact your nearest SHIBA representative at 1-800-247-4422