Senior Medicare Patrols

Last updated

The Senior Medicare Patrols (SMP) are a group of volunteer organizations funded by the United States Department of Health and Human Services, which educate U.S. senior citizens on how to prevent, detect, and report Medicare and Medicaid fraud, error, and abuse. From the program's start in 1997 through December 2019, SMP projects and staff have recovered about $129 million in Medicare and Medicaid funds, and between 2016 through 2019, the program led 107,000 group education sessions and reached an estimated 6.5 million people through community education events. [1] SMP has trained over 30,000 volunteers and received more than 300,000 complaints for investigation. [2] Further, but untrackable, reductions in fraud and error likely occur because of beneficiaries' increased scrutiny of their bills.

Contents

In August 2020, the Administration for Community Living awarded funding to the Northeast Iowa Area Agency on Aging to act as the Senior Medicare Patrol National Resource Center (SMPNRC). Planned initiatives include maintenance of the public facing website and a mobile application. [3]

See also

Related Research Articles

United States Secretary of Health and Human Services Government position

The United States secretary of health and human services is the head of the United States Department of Health and Human Services, and serves as the principal advisor to the president of the United States on all health matters. The secretary is a member of the United States Cabinet. The office was formerly Secretary of Health, Education, and Welfare. In 1980, the Department of Health, Education, and Welfare was renamed the Department of Health and Human Services, and its education functions and Rehabilitation Services Administration were transferred to the new United States Department of Education. Patricia Roberts Harris headed the department before and after it was renamed.

Medicaid United States social health care program for families and individuals with limited resources

Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The main difference between the two programs is that Medicaid covers healthcare costs for people with low incomes while Medicare provides health coverage for the elderly. There are also dual health plans for people who have both Medicaid and Medicare. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."

United States Department of Health and Human Services Department of the US federal government

The United States Department of Health and Human Services (HHS), is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

Medicare (United States) United States single-payer national social insurance program

Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.

Centers for Medicare & Medicaid Services United States federal agency

The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act.

Administration on Aging USA government agency

The Administration on Aging (AoA) is an agency within the Administration for Community Living of the United States Department of Health and Human Services. AoA works to ensure that older Americans can stay independent in their communities, mostly by awarding grants to States, Native American tribal organizations, and local communities to support programs authorized by Congress in the Older Americans Act. AoA also awards discretionary grants to research organizations working on projects that support those goals. It conducts statistical activities in support of the research, analysis, and evaluation of programs to meet the needs of an aging population.

This article refers to the health care company Primaris. See also Primaris Airlines and Primaris REIT.

Long-term care Services for the elderly or those with chronic illness or disability

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.

Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.

In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.

CentraCare Health is an integrated health care system in Central Minnesota. The nonprofit includes six hospitals, seven senior care facilities, 18 clinics, four pharmacies and numerous inpatient and outpatient specialty care services. The organization received national attention in the spring of 2021 for its innovative outreach via mobile Covid vaccine unit especially to address vaccine hesitancy by meeting people on their turf and providing extended time for one-on-one consultations, answering questions and helping to dispel disinformation-based fears.

Healthcare reform in the United States has a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes enacted in 2010: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.

Amerigroup is an American health insurance and managed health care provider. Amerigroup covers 7.7 million seniors, people with disabilities, low-income families and other state and federally sponsored beneficiaries, and federal employees in 26 states, making it the nation’s largest provider of health care for public programs.

SCAN Health Plan

SCAN Health Plan(SCAN) is a not-for-profit, Medicare Advantage, health maintenance organization (HMO) based in Long Beach, California. Founded in 1977, they provide healthcare coverage to Medicare beneficiaries throughout the state, currently serving nearly 200,000 members. They are one of the largest not-for-profit Medicare Advantage Prescription Drug plans in the country.

Older Americans Act Federal initiative aiming to provide services to older adults

The Older Americans Act of 1965 was the first federal level initiative aimed at providing comprehensive services for older adults. It created the National Aging Network comprising the Administration on Aging on the federal level, State Units on Aging at the state level, and Area Agencies on Aging at the local level. The network provides funding – based primarily on the percentage of an area's population 60 and older – for nutrition and supportive home and community-based services, disease prevention/health promotion services, elder rights programs, the National Family Caregiver Support Program, and the Native American Caregiver Support Program.

The Pennsylvania Department of Aging is a cabinet-level agency charged with providing aid to Pennsylvania's approximately 3 million individuals age 60 and older. Although the bureau operates some services directly, such as the Pharmaceutical Contact for the Elderly (PACE) prescription drug program, it generally serves as a clearinghouse of funding and information for county-level Area Agencies on Aging. The department was formed under the governorship of Milton Shapp.

The Oklahoma State Budget for Fiscal Year 2008, was a spending request by Governor Brad Henry to fund government operations for July 1, 2007–June 30, 2008. Governor Henry and legislative leader approved the budget in May 2007.

Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called "insurance navigators" or "in-person assisters" who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. "Navigators" work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.

As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.

References

  1. Murrin, Suzanne. "Memorandum Report: 2019 Performance Data for the Senior Medicare Patrol Projects" (PDF). U.S. Office of Inspector General, Department of Health and Human Services. p. 8. Retrieved 17 March 2022.
  2. "Senior Medicare Patrols Help to Stop Medicare Fraud - ExpertMedicare.com" . Retrieved 2016-08-09.
  3. "Senior Medicare Patrol National Resource Center Funding Awarded | ACL Administration for Community Living". acl.gov. August 31, 2020. Retrieved 17 March 2022.