Senior Medicare Patrol billing review and anti-fraud services.
Most states and the Area Agencies on Aging centers operate the Senior Medicare Patrol. The goal of this program, also known as SMP, is to ensure seniors, especially those who are Medicare or Medicaid beneficiaries, are billed accurately. The United States Administration on Aging originally created and funded the program as an anti-healthcare fraud service. Find how to apply for free advice and support from the SMP program below.
Senior Medicare Patrols are located throughout the nation, and a number of volunteers participate in the program. Each person who participates will do their best to help senior citizens and the elderly, and ensure that they are empowered to address issues of medical billing errors, health care fraud, scams, abuse and other related issues.
Professional staff and volunteers hold workshops and can meet with individuals to provide education, advocacy, and assistance to residents of their state and county in order to identify and prevent Medicaid and Medicare abuse. They will also report on other health care issues such as internet drug scams and identity theft to name but a few. Services will vary by state and Agencies on Aging office, but in general Senior Medicare Patrols (SMP) will offer:
Workshops and presentations. These are held for groups of senior citizens, their caregivers and others who need assistance with medical bills or who are concerned with fraud. The sessions are usually held at Agencies on Aging offices, and they will cover the various types of abuse and fraud that occur. The sessions will help people identify common errors. They will review with individuals the steps that seniors can take to protect themselves from these issues.
Sessions will provide information of government health care such as Medicare and Medicaid. Learn your rights, what these programs typically provide, and how much seniors and others may typically need to pay for their medical costs and prescription medications.
Receive one-on-one counseling, advice, and assistance. For example, many people have questions about possible incorrect medical bills. Many others need help in understanding their health care documents, or want to know how to identify Medicare or Medicaid fraud. This is when Senior Medicare Patrol counselors can really help. They are available to assist seniors with understanding their bills, review their cases and other paperwork.
Some of the more common examples of incorrect billing or health care fraud can include:
- Double billing, which is charging more than once for the same service.
- Billing for services or medical equipment that was not ordered, or that was different from what was provided.
- Upcoding, which is billing a senior for more expensive care or a service when a less expensive, non-covered item was provided.
- Changing or altering claim forms to obtain a higher payment amount from Medicare.
- Falsely reporting to the patient or government that certain types of services or health care is medically necessary when they are not.
- Billing for home health care or medical equipment after it has been returned to the provider.
- Unbundling involves charging the senior a higher amount on their care than if they are combined and billed as one service.
- Other assistance can help with Identity Theft, Home Health Care Fraud, Explanation of Medicare Summary Notice (MSN) & Explanation of Benefits (EOB), Wheelchair and Scooter Scam, and General Consumer Protection.
Specialists from the Senior Medicare Patrol will offers tips to help the elderly and senior citizens identify and detect billing errors, scams, or fraud. Read more on medical billing errors. Some of the tips and recommendations they will have include the following.
Always be sure to request, and closely review, the explanation of your Medicare summary notices (MSN) as well as Medicare/Medicaid benefits (EOMB). These need to properly reflect services that you received from your doctor or hospital. The payment notice will tell you what you owe, what health care services or supplies were billed to Medicare, and exactly what the Medicare program paid towards your bills. Be sure to closely review all bills and statements for any charges that seem wrong to you. This can include services not ordered by your doctor, charges for something you didn’t get (such as medications), or billing for the same health care service twice. If you did happen to spend time in a hospital, make sure this was billed accurately. Review the admission date, discharge date, and ensure the diagnosis and details on your medical bill is correct.
Keep accurate and detailed records. Guidelines from the Senior Medicare Patrol will state to always keep a record of your health care services and appointments. You can do this by simply using a calendar to record all of your doctor's appointments. Note which services were provided, such as tests or X-rays. Then, once you get your medical bill or Medicare statement, be sure to carefully check it to make sure you received each service listed and that all the details on the statement are correct. Click here for other methods to use for reducing medical bills, including how to get medical bill reduction from advocates.
Another small suggestion is to always count your medications and pills before your leave the drug store to be sure you have received the full amount. If you notice that you did not receive your full prescription, then report the problem immediately to the pharmacist.
Applying to and phone number for Senior Medical Patrol
To learn more about the Senior Medicare Patrol program (SMP), fraud, and billing issues, contact your local Agency on Aging office. Or dial 877-808-2468.