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State Wants Citizens to Help Fight Medicare Fraud

Wednesday, November 21, 2012


The Rhode Island Department of Human Services, Division of Elderly Affairs (DEA) is seeking volunteers to help stop Medicare fraud in RI by working with the Senior Medicare Patrol (SMP) program. SMP volunteers educate and empower Medicare beneficiaries, their families, and their caregivers to detect and report Medicare and Medicaid fraud. In addition to protecting beneficiaries from fraud, SMP volunteers help to preserve the integrity of these programs.

Because face-to-face contact is often the most effective means of fighting fraud, SMPs nationwide draw approximately 5,000 active volunteers a year. Last year in RI there were 40 active SMP volunteers. They worked over 700 hours to resolve nearly 8,000 simple fraud inquiries. One-on-one counseling sessions jumped from 53 in 2010 to 1,759 in 2011.

“DEA is committed to increasing awareness of Medicare fraud and abuse among Rhode Island beneficiaries,” declared Director Catherine Taylor. “This awareness is the pivotal information that can help them to avoid becoming victims of medical identity fraud, and other scams that are designed to steal their money or assets.”

“SMP volunteers are critical in getting this information into the community and on the minds of the state’s Medicare beneficiaries. We need to know that SMP can help,” she observed.

U.S. Health and Human Services Director Kathleen Sebelius notes that taxpayers lose more than $60 billion annually to health care fraud. According to the national SMP office, prosecution of health care fraud cases is up 75 percent since 2008. Healthcare fraud may mean that someone charges an individual or their insurance for a service that was never provided or for a service that was different from what was provided. Fraudulent charges often prevent people from getting important health care services that they need.

With the goal of educating local consumers about health care fraud, waste and abuse, the RI SMP program partners with agencies across the state so that Rhode Islanders can visit or call if they suspect fraud. SMP volunteers help seniors check paperwork such as Medicare notices and billing for mistakes and discrepancies.

In-person counseling, as well as general education sessions, are available through six RI SMP program partners: United Way/2-1-1 in Rhode Island, Tri-Town Community Action Agency (401-351-2750); South County Community Action Agency (401-789-3016); the East Bay Community Action Program (401-437-1000); the West Bay Community Action Program (401-732-4660); and Child and Family Services of Newport County, Inc. (401-848-4185).

In 2011, nearly 100 community outreach education events were conducted in RI by local SMP volunteers reaching an estimated 4,223 RI residents.


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