Senior Medicare Patrol Projects Empowering Seniors To Prevent Health Care Fraud

Post Date

February 15th 2012

Application Due Date

March 19th 2012

Funding Opportunity Number

HHS-2012-AOA-MP-1202

CFDA Number(s)

93.048

Funding Instrument Type(s)

Cooperative Agreement

Funding Activity Categories

Income Security and Social Services

Number of Awards

28

Eligibility Categories

State Governments
County Governments
City or Township Governments
Special District Governments
Public and State Controlled Institutions of Higher Education
Federally Recognized Native American Tribal Governments
Non-Federally Recognized Native American Tribal Organizations
Non-Profits With 501 (c) (3) Status With The IRS (Except Higher Education Institutions)
Private Institutions of Higher Education
Other

Faith-based organizations, community-based organizations, lesbian, gay, bisexual, transgender LGBT) organizations and hospitals

Funding

• Estimated Total Funding:

  $4600000

• Award Range:

  $0 - $180000

Grant Description

The Department of Health and Human Services (DHHS) Office of Inspector General estimates that Medicare loses billions of dollars each year due to errors, fraud, and abuse. These losses are due, to a considerable extent, to the many ways in which the funds are disbursed as well as to the sheer magnitude of health care expenditures. Both factors increase the probability of errors while opening wider opportunities for fraud and abuse. While the vast majority of health care providers are honest, those operating unscrupulously, intent on obtaining vital health care dollars illegally, have done so based on the perception that the risks of detection have lessened over the years. Beginning in 1997, the AoA established twelve local demonstration projects designed to recruit and train retired professionals, such as doctors, nurses, teachers, lawyers, accountants, and others to identify and report error, fraud, and abuse. Implemented through the Omnibus Consolidated Appropriation Act of 1997 (Public Law 104-208), Senate Report 104-368 noted that рsenior citizens are our best front line defense against these losses, but they often donуt have the information and experience neededс to recognize and accurately report cases of error, fraud, and abuse. The Report further noted that рthousands of retired accountants, health professionals, investigators, teachers, and others и with appropriate training could serve as volunteer expert resources and educators for seniors in their communities.с Accordingly, these projects have worked to test different models designed to train retirees in local communities to serve as both volunteer resources and educators for other Medicare beneficiaries, and to build and strengthen community coalitions of older Americans and service providers. In 2011, the SMP Program will include an estimated 54 project grants in all states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. SMP projects have made great progress in recruiting and training retired professionals and other senior citizens on Medicare error, fraud and abuse. These volunteers work in their communities, senior centers and elsewhere to educate Medicare beneficiaries, family members, and caregivers to actively protect themselves against fraudulent, wasteful and abusive health care practices by reviewing their Medicare benefit statements and reporting suspected errors. SMP projects actively work to disseminate SMP fraud prevention and identification Information through the media, outreach campaigns, community events and many other means. Through these efforts, beneficiaries contact the projects with inquiries and complaints regarding Medicare, Medicaid and other health care or related consumer issues. Another key role of the SMP project is to address such inquiries and complaints, either by resolving matters directly or by referrals to appropriate entities. SMP projects refer numerous beneficiary complaints to state and national fraud control /consumer protection entities, including Medicare contractors, state Medicaid fraud control units, state attorneys general, the OIG, and the Centers for Medicare & Medicaid Services (CMS). Capturing SMP program activity data, to include tracking and reporting of beneficiary complaints, referrals, savings and other outcomes in the SMART FACTS system is also a key function of the SMP project. The AoA also receives Health Care Fraud and Abuse Control (HCFAC) funding as authorized by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The HCFAC funds, which are received from the Medicare Trust Fund, are used to support infrastructure, technical assistance, and other SMP program support and capacity-building activities designed to enhance program effectiveness. The National Consumer Protection Technical Resource Center (the Center), an AoA grantee, provides training and technical support including mentoring of new projects, disseminating best practices and innovations, technical assistance, training and support of SMP project implementation and effective use of AoAуs SMART FACTS management tracking and reporting system. In addition, HCFAC funding supports a National Hispanic SMP project focused on targeted outreach to Hispanic beneficiaries, their families and caregivers.

Contact Information

• Agency

  Department of Health and Human Services

• Office:

  Administration on Aging

• Agency Contact:

  Sean Lewis
  Grants Management Specialist
  Phone 202-357-3445

• Agency Mailing Address:

  Agency Contact

• Agency Email Address:

  Sean.Lewis@aoa.hhs.gov

• More Information:

  Program Announcement