OIG: Volunteer Medicare fraud patrols had declining recovery in 2011

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The success rate of Medicare's volunteer force of fraud-detecting beneficiaries is declining, a government report finds.

Senior Medicare Patrol projects recovered 17% less in 2011 than they did in 2010, according to the Department of Health and Human Services Office of Inspector General. In 2011, volunteers recovered $32,941 in 2011 from Medicare and Medicaid programs, compared to $40,000 in 2010, even as the number of SMP volunteers increased 14% between 2010 and 2011.

SMPs, which were given grants last year totaling $9 million, train seniors, caregivers and beneficiary family members to review Medicare notices and Medicaid claims for signs of fraudulent activity.

However, an important caveat is that that patrols may be alerting contractors to cases of fraud. In one of these cases, a Medicare contractor is seeking to recover $2.9 million in overpayments by a provider identified by a volunteer.

According to the report, because SMP volunteers are told to report suspicious activity to contractors, cases of fraud and abuse can't always be tracked and that the “projects may not be receiving full credit for savings attributable to their work.”

Click here to read the full report.