When it comes to Medicare fraud, Massachusetts has a dubious distinction: The Bay State is among a number of states with the highest incidence of Medicare fraud or the highest potential for such fraud, according to the federal Administration on Aging. As recently as last month, two business partners in the state were charged with bilking the Medicare system to the tune of $27 million over a 6-year period.
“Massachusetts, with its landmark health reform legislation, has taken a lead in controlling health care costs,” said Lucilia Prates, director of the Massachusetts Senior Medicare Patrol Program (MA SMP), which is hosted by Elder Services of the Merrimack Valley. “Our individual efforts to reduce errors, fraud and abuse will help to protect and strengthen Medicare and Medicaid for today’s beneficiaries as well as for those in the future.”
YOU can help reduce Medicare fraud and billing errors, which jeopardize the future of the program, by volunteering a few hours with the MA SMP. AARP is helping combat Medicare fraud and errors by supporting the efforts of the MA SMP program, in which volunteers are trained to notice errors and spot questionable bills.
As an MA SMP volunteer, you’ll meet with Medicare recipients in group education sessions or community events, and help them go through their medical bills and statements. Based on your training, you’ll also help them better understand their Medicare Summary Notices and Explanation of Benefits statements.
George Lamont, a retired executive who began volunteering with the Senior Medicare Patrol Program last year after receiving an email notice about the opportunity from AARP, says protecting the Medicare program was what motivated him to sign up. “As a [retired] senior I recognized how valuable Medicare is for me, and to make sure all Medicare monies are going where they’re supposed to is something every senior should be concerned about.” George, one of 40 active MA SMP volunteers who is also a volunteer with the AARP Tax-Aide program, said he saw an AARP ad about the MA SMP program and decided to call and learn more.
George explained that seniors who reach out for help with their medical bills and Medicare statements begin the process. “Any error we uncover is really the result of someone calling us and asking questions about their bills or their summary notices,” he said, “and then they’ll indicate there’s been a problem.”
Asked if he’s helped uncover cases of Medicare fraud and billing errors, George replied, “I had a case of an identity issue when [the patient] was charged about $7K by an out of state hospital. Through calls, we were able to resolve that issue,” said George. There have been other small things—let’s call it fraud—such as a doctor who’d been charging Medicare for a treatment that only qualified if the patient had diabetes or neuropathy conditions—and she [the patient] didn’t have either but the doctor was indicating that was the case. It didn’t turn out to be a lot of money, but it was found to be a discrepancy.”
Part of volunteering with the Senior Medicare Patrol Program is learning more about Medicare Summary Notices and Explanation of Benefits statements, and then passing that knowledge on to others. “If seniors look at a Summary Notice and it says they don’t owe anything, they don’t look any further,” George said. “Generally, we’re contacted by a beneficiary who’s seeing something that’s in their bill that isn’t right, and then they ask for our help.”
Being a volunteer with the Massachusetts Senior Medicare Patrol Program allows you to make a difference right in your own community, and do your part to help control health care costs.
Just ask George: “From a personal [perspective] it’s a wonderful education about exactly what I should be looking for, personally. Anytime you get involved with something that can further your education about what costs may not be paid or what might not be covered [is beneficial].
“Then there’s the personal satisfaction of being able to help a lot of people who perhaps aren’t quite as well off or knowledgeable and need help. And knowing I’m doing something that will help protect Medicare—I’ve got a benefit I don’t want to go away, so I’m doing something to help keep it healthy. Can you imagine what an insurance policy would cost for someone over age 65 with preexisting conditions?! I just hope that we can find plenty of seniors and volunteers who want to join in on the fight!”
For information about becoming a volunteer with the Massachusetts Senior Medicare Patrol Program, please visit the MA SMP Program website or call the SMP Program staff at 800-892-0890.