Compliance: Big Brother is Watching for Fraud and Abuse

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This compliance-focused article describes the Senior Medicare Patrol (SMP), a Medicare beneficiary education and reporting program highlighted in an OIG performance report. It explains the program’s role in spotting potential fraud, waste, abuse, and scam activity, and why providers may be concerned when billing patterns draw attention. The piece is relevant to compliance staff, medical practices, coders, and anyone monitoring Medicare billing integrity.

Why This Topic Matters

The article matters because it shows that billing and coding patterns can be observed by non-government participants in the Medicare ecosystem and may trigger further review. It also underscores the importance of compliance awareness for practices serving Medicare beneficiaries.

What You Will Learn

  • What the Senior Medicare Patrol is and who participates in it
  • How Medicare beneficiaries and families are educated to recognize suspected fraud and abuse
  • Why reporting patterns can matter to provider compliance concerns
  • How an OIG report is used to describe program performance and recoveries

Who Should Read This

  • Medical coders
  • Compliance officers
  • Medical practice managers
  • Billing staff
  • Physicians
  • Medicare providers
  • Healthcare auditors

Codes Discussed

  • CPT: 99215

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