SMP’s purpose is to educate and empower beneficiaries to take an active role in the detection and prevention of health care fraud and abuse, with a focus on the Medicare programs. In order to accomplish this, the program recruits, trains and guides retired professionals as volunteers to help seniors become better healthcare consumers. The volunteers work in their own communities where seniors congregate.
They strive to educate beneficiaries on how to monitor what is paid on their behalf and to identify deceptive health care practices, such as, bundling charges to hide non-covered fees, filing bogus claims for products or services never rendered, altering billing codes to inflate Medicare claims and ordering unnecessary or inappropriate products or services to increase revenues.
SMP staff and trained volunteers:
- Partner with the aging services network, law enforcement, and others to promote community awareness of health care errors, fraud and abuse;
- Develop and distribute consumer education materials about Medicare, Medicaid and fraud, errors and abuse through presentations, health fairs, and press events;
- Provide consumer counseling, and when necessary serve as consumer advocates to resolve billing disputes/ issues;
- Make appropriate referral to health care agencies and law enforcement for suspected cases of errors, fraud or abuse; and
- Support technical assistance efforts designed to share and replicate common strategies and successful practices.