Senior Medicare Patrol

Consumer Information

Why Should You Care About Health Care Fraud, Errors, and Abuse?

Health care fraud is not just about the government. People can get sick, lose benefits, lose money, and get stuck with bad equipment or other things they don’t need. The Medicare and Medicaid programs provide security for all of us. We want to ensure these programs will have money to operate and to provide good, quality health care for you and future generations. Although the vast majority of health care providers are honest, the activities of the remaining few result in wasted funds and a loss of quality of care for yourself and others.

Health Care Fraud Costs!

In the United States, we lose as much as $80 - $100 billion each year to health care
fraud and errors. Medicare lost more than $16 billion dollars to fraud, abuse and
errors in 2004. Consumers lose as much as $10 billion dollars a year.

What is Fraud and Abuse?

Fraud is an intentional deception or misrepresentation which could result in unauthorized benefit. Abuse is incidents or practices inconsistent with sound medical or business practices.

Who Might Commit Health Care Fraud?

Fraud and abuse can occur in these areas:

Hospitals
Nursing Homes
Home Health Services
Physician’s Offices
Durable Medical Equipment (DME)
Medical Equipment Suppliers
Pharmacies
Hospice Services
Laboratories
Transportation Providers

SMP Accomplishments

Since 1997, the Senior Medicare Program has reached out to more than 1.8 million seniors / consumers and played a role in the recovery or savings of more than $100 million dollars and saved the Medicare program $3.9 million. Last year alone, Medicare lost $12.9 BILLION to error, fraud and abuse. In 1997, when the SMP program began, Medicare was losing 24 billion.

In 2003, the SMP projects documented and investigated nearly 15,000 consumer complaints and inquiries, trained more than 45,000 volunteers and conducted more than 134,000 media and community events.