July 24, 2020

The Office of the Inspector General, Health and Human Service (OIG HHS) produces an annual SMP report.  Here is a synopsis of the 2019 CY report.

In 2019, the 54 SMP projects had a total of 6,875 active team members who conducted a total of 28,146 group outreach and education events, reaching an estimated 1.6 million people. In addition, the projects had 320,590 individual interactions with, or on behalf of, a Medicare beneficiary.

For 2019, the SMP projects reported $2.4 million in expected Medicare recoveries. Almost all of these recoveries came from one project that uncovered a fraud scheme that encouraged low income senior citizens to submit DNA samples for medically unnecessary genetic testing. Three defendants were sentenced and ordered to pay a total of $2.3 million in restitution and forfeitures.  In addition, cost avoidance totaled $60,971, while savings to beneficiaries and others totaled $20,150.

In addition, the SMP program released a consumer fraud alert on genetic testing.  The alert advises beneficiaries to be suspicious of strangers who offer free genetic tests. It also advises beneficiaries to be cautious about sharing their personal information, including their Medicare identification number, and warns that this information can be used to fraudulently bill Medicare and Medicaid. The SMP projects conducted 1,467 group events covering genetic testing fraud issues in 2019; these events reached 97,455 people.

In comparison to 2018, the projects reported a 15-percent increase in the number of individual interactions in 2019 (320,590, up from 278,761). The number of group outreach and education events increased slightly by 5 percent, but the number of people reached through these channels decreased by about the same percentage (1.6 million, down from 1.7 million). In addition, the projects reported significantly higher amounts for Medicare recoveries ($2.4million, up from $15,136), while cost avoidance dropped ($60,971, down from $602,063).

The OIG HHS notes SMP projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work. It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of their bills reduces fraud and errors.

To read the full report, click here.

Source:  Office of the Inspector General Health and Human Services