Outpatient Facility Coding Alert - 2009 Issue 34
COMPLIANCE: Senior Medicare Patrol Recovered $4.5 Million by Watching for Fraud and Abuse
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Article Overview
This compliance-focused article describes the Senior Medicare Patrol (SMP) program and how it supports detection of Medicare fraud, waste, and abuse. It is relevant to providers, compliance staff, and billing professionals who want a broader understanding of how patient-reported concerns and government oversight can surface questionable billing patterns. The article covers the program’s purpose, the types of issues volunteers are trained to notice, and the role of OIG oversight and reporting.
Why This Topic Matters
It highlights a beneficiary-driven fraud surveillance program that can bring billing and coding concerns to the attention of investigators. Understanding the SMP helps practices recognize why certain claims patterns may attract scrutiny and how external reporting can affect compliance review.
What You Will Learn
- What the Senior Medicare Patrol program is and who participates in it
- How volunteers are trained to recognize broad fraud and abuse concerns
- How reports can lead to review of billing patterns and provider practices
- What role the OIG plays in monitoring program-reported issues
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Healthcare administrators
- Physician practices
- Medicare providers
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