Senior Medicare Patrols (SMPs) help Medicare beneficiaries and their families detect and report healthcare fraud. SMPs across the country conduct outreach and educate, engage volunteers, and receive complaints on a daily basis. In this week’s episode,we welcome guest Stacey Platte, Director at the Administration for Community Living @aclgov to talk about the role that SMPs play in the fraud prevention in the elder care community.
Schenk: Welcome to the episode this week. Sorry about that. I don’t know if I’m going to edit that out or not, but any time I go to introduce the episode, that’s Will’s cue to take a drink. It’s like a very thirsty Pavlov’s dog.
Schenk: But actually Pavlov – that was what the…
Smith: It was food though, not water.
Schenk: Was it? It was food or water?
Smith: I thought it was food.
Schenk: Yeah, I guess it was food. So my metaphor…
Smith: It’s sustenance of some kind. The canines were trying to get sustenance.
Schenk: Yeah. But at any rate, that’s the reason for our delay in the beginning of this episode.
Smith: All my fault.
Schenk: All Will’s fault. Today, a lot of – this will be a good episode to provide you insight on a resource that is I guess at all of our disposals – the taxpayer’s disposal with regard to Medicare fraud. And we’re going to be talking today about Senior Medicare Patrols and what their job is in sniffing out fraud.
Schenk: SMPs. What was the thing in the Matrix – we’re probably getting off too many tangents – in the Matrix where they hit the button and it kills all the robots? It was an EMP?
Smith: Oh, yeah.
Schenk: We’re talking about SMPs.
Smith: Electromagnetic pulse, yeah.
Schenk: Yeah, and today, to talk about SMPs, we have straight from CMS, Stacey Platt. Will, can you tell us about her?
Smith: So Stacey is the senior Medicare Patrol program director in the Administration for Community Living. Prior to joining ACL, which is the Administration for Community Living, she was a health insurance specialist for the Centers for Medicare and Medicaid Services, CMS. Stacey has worked with the SMP and SHIP programs in various positions at the local, state and national levels for the past 15 years. So Stacey holds a master’s in social work and a BA from the University of Michigan and we are happy to have her on the podcast today.
Schenk: Stacey, welcome to the show.
Stacey: Thanks so much for having me.
Schenk: All right. Well Stacey, the big question is, the first question, threshold question is what is a Senior Medicare Patrol?
Stacey: The Senior Medicare Patrol is a program that empowers and assists Medicare beneficiaries, their families and their caregivers to prevent, detect and report healthcare fraud and areas of abuse, primarily in the Medicare program.
Smith: Okay. So how does that shake out? What is that exactly?
Stacey: Yeah, so SMP volunteers and staff, they serve as the eyes and ears in their communities, if you will, teaching people with Medicare to be the first line of defense against Medicare fraud. And they do that through local outreach and education events, and they also do personalized one-on-one counseling for folks who think they may have been the victims of Medicare fraud.
Smith: So where do these volunteers come from?
Stacey: SMPs recruit volunteers within their state who are interested in making a difference in their community and working to ensure that the Medicare program is protected for future generations. So SMPs recruit volunteers in a variety of different ways. Some folks are using social media now to recruit, but a lot of times it’s word of mouth or newspaper or television advertisement that are used to recruit volunteers.
Schenk: So that makes sense. So this is nationwide. So depending on where the audience is, theoretically if they’re in Missouri, they can contact a local Senior Medicare Patrol or there’s one office? Can you tell us where your offices are and that kind of thing?
Stacey: Yeah, it is a nationwide program and we have one program in each of the 50 states, D.C., Puerto Rico, Guam and the U.S. Virgin Islands. People can find their local SMP programs by going to www.smpresource.org or by calling 1-877-808-2468.
Smith: Okay, and we’ll put that up on the screen.
Schenk: Yeah, we’ll put that on the screen.
Schenk: Just a quick question – do you happen to know Nathan Coughlin?
Stacey: I do not.
Schenk: Okay, we had him on as a guest on the show. Oh, where are we at now? This would have been in February of 2019, we had him on the show and he works for the Georgia Senior Medicare Patrol. So I didn’t know if you guys all ran in the same circles. I guess that’s like asking one FBI agent if they know all the other FBI agents.
Anyways, sorry about that. Here’s a 40,000-foot question here. What constitutes Medicare fraud? What is it that you are going after exactly?
Stacey: Yeah, so in a lot of cases, we’re looking to find cases where people are being billed for services or supplies that were not actually provided. In some cases, it can be looking out for providers who are prescribing or providing excessive or unnecessary tests or services. It can be looking out for cases where a provider may misrepresent a diagnosis or a person’s identity or the service that was provided or otherwise falsify facts to justify getting paid by Medicare.
Schenk: So here’s a – it might be a dumb question, but is it kind of the standpoint of the SMP to prevent like improper medical treatment or to uncover just overtreatment for the purposes of billing more? Does that make sense? Does that make sense to you? Like are you concerned more about the health of the person or uncovering someone trying to make more money off the government?
Stacey: Well as far as the improper medical treatment, we don’t get involved in that side of it. We won’t make judgments on what it was or was not improper medical treatment. We’re more looking at were the things that were billed for actually provided? Do they make sense? Does it look like there are errors? Does it look like a provider may be billing for things that don’t make sense based on our knowledge of the Medicare program? Things like that – we don’t get so much involved on the medical necessities side.
Schenk: Got you. That’s a good segue. What are some of the more common types of healthcare fraud that you guys are detecting? Is it like fancy medical beds that aren’t needed? What do you guys see often over and over again?
Stacey: Yeah, so over the past year, we’ve had two particular trends that we’ve seen more than others. One of them has related to durable medical equipment scams whereby people with Medicare are mailed back braces and knee braces and other types of braces that were not medically necessary and were not prescribed by their primary care physician, and this often leads to people with Medicare to end up with multiple braces that don’t meet their needs and that Medicare was billed for unnecessarily.
Schenk: Is there a reason you know of why that would be specifically more common? Is it easier – are the forms that people fill out easier to fill out for back braces and that kind of thing? Why that versus something else?
Stacey: Yeah, the back braces and knee braces and related items, they seem to be easier to fly under the radar and get approval for, and there are a lot of telemarketing scams related to this right now, so people with Medicare are getting phone calls offering these pieces of equipment and it’s been much more common over the past year.
Smith: Oh, people with Medicare are getting those phone calls.
Schenk: I have a whole closet of back braces because of the scams that are calling me. I get eight calls a day.
Smith: It’s ridiculous now.
Schenk: Yeah. That makes sense. So okay, then how is the fraud detected on your end? So you’re just going through different codes and you have software that just a red flag goes off and you all go slide down the pole like the fire department and you go drive off? How do you guys know that that’s happening?
Stacey: So no, we don’t have any of that unfortunately. Medicare has that on their side through the Medicare program, but in our cases with the Senior Medicare Patrol, really we’re out there and talking to people in the community. People are calling us and letting us know that they’ve been receiving these phone calls for these shipments of different pieces of equipment and that is how we find out about it and help them go forward and troubleshoot, return that equipment, get the claims reversed and all of that.
Smith: So how much do you guys get involved with the legal actions of qui tam or false claims acts?
Stacey: We don’t from our side. If we encounter pieces where we think that those are concerns, we have a referral process with the HHS Office of Inspector General, and so we would refer cases to them for investigation.
Schenk: Got you. Understood. So other than the back braces and the knee braces because those are kind of fly under the radar because everybody needs back braces and knee braces, are there other types of more common Medicare fraud that you are aware of?
Stacey: Yeah, so over the past year we’ve seen a lot of scams also related to the new Medicare card rollout. So if you may know, over the past year, Medicare has been sending new cards to everyone with Medicare that has a new Medicare number on the card, which is a great thing and is really intended to reduce the amount of fraud in the program and protect beneficiaries information, but it’s also resulted in a number of scams, so telemarketers as well calling to ask people with Medicare to disclose personal or financial information in order to receive their new Medicare card. So SMPs have been doing a lot of education this year to let people know that they don’t need to provide that information. Medicare won’t call them and ask for that information and they should always protect their personal information.
Smith: Got you.
Schenk: And when does that roll out? When do the new Medicare cards come out?
Stacey: So the rollout has actually ended. It started in April of 2018 and I believe it just ended last month, so it was a little ahead of schedule. They were able to get those cards mailed out across the country, but if folks have not received a new card yet, they can call 1-800-MEDICARE and check on the status and get mailed a new on if they need it.
Schenk: I should call my mom, see if she got hers.
Schenk: It’s probably in the drawer that has like all the taco sauce and hot sauce stuff. That’s where all the mail goes. It’s too scary for her to open. Just kidding, Mom. I hope you’re not – actually, Mom is one of the listeners. So sorry about that, Mom, just kidding.
So can you speak a little bit about – obviously don’t give out your Medicare information to somebody on the phone, but are there any other ways that people can avoid being subject to or part of healthcare fraud?
Stacey: Yeah, absolutely. So the Senior Medicare Patrols key message is “Protect, detect and report.” So like you mentioned, protect – protect that information, guard your Medicare card like it’s a credit card. Don’t give out that number. But also do what you can to try and detect Medicare errors or fraud, and in many cases, that will involve reviewing the quarterly Medicare summary notices that come to everyone with Medicare every three months, and those notices include all of the things that Medicare and you have been billed for over the past quarter. So we really encourage folks to take a look at that closely, to call their providers and suppliers if they have any questions. And if they do see anything that looks like a potential error or fraud, to report it to their local SMP so they can get help investigating that.
Smith: That’s really good information because I guarantee you – I know my mother doesn’t, and I’m sure your mom doesn’t, Rob, look at those quarterly statements.
Schenk: They’re, again, if the mail doesn’t get posted on the side of the refrigerator with the magnet, it goes into the drawer where the soy sauce is.
Smith: So that’s good information that they have a quarterly statement. People need to start looking at those statements.
Schenk: Correct. Correct. Here’s a logistical question, Stacey. How are you guys staffed? What’s the staffing? How many of you are there? Obviously you don’t know Nathan here in Georgia, but tell us about that.
Stacey: Sure. So I work at the headquarters for the Administration for Community Living and I oversee the SMP program nationally, but we do have an SMP director, paid SMP director in each state and territory that we provide SMP funding to, and that director oversees all of the SMP activity in the state, and you know, sometimes they have a small staff, but mostly they recruit and train and lead a team of volunteers who do SMP outreach and counseling in their state. And the reason why I probably don’t know Nathan personally is because we have about 650 paid members across the country who work on Senior Medicare Patrol programs.
Schenk: Well you’re going to hurt his feelings because he knew who you were. I’m kidding. So what else can we talk about in terms of Medicare fraud? Is there any other kind of key tips or takeaways that our audience can use?
Smith: Or resources they can access?
Schenk: Or resources?
Stacey: Sure. Well there’s a lot of good information available on the Medicare website as well about Medicare fraud. We always encourage folks to use Medicare.gov as a resource. We sometimes will also refer folks to the Federal Trade Commission if they need to report certain kinds of scams or identity theft. And SMPResource.org is the website for the national SMP program. You can find your local SMPs there and also take a look at Medicare fraud resources.
Schenk: That makes sense. And the FTC, the scams you’re talking about, that’s the Federal Trade Commission, so that would be I guess scams involving email or telephone?
Stacey: Yes, most often.
Schenk: Yeah. Well great, Stacey. This episode has flown by. It’s a lot of good information for our audience. We really appreciate it. And again, one more time for the audience, how can our audience call or visit the website? What’s the phone number? What’s the website?
Stacey: Sure. The phone number for our National SMP Resource Center is 1-877-808-2468, and you can also use their website to find your local SMP program. The website is www.smpresource.org.
Schenk: Awesome. Thank you so much, Stacey. Really appreciate it.
Stacey: All right, thanks a lot.
Schenk: Thank you. Great. So Senior Medicare Patrol, and again, we’ll have the website up on the screen, but if you’re interested, if you’re in Georgia, we covered this topic in Episode 104 with Nathan Coughlin with Georgia Senior Medicare Patrol, so we encourage you to go and listen to that episode as well, do a two-fer, an SMP two-fer.
So again, one more reminder, this will be the third reminder, that May is Older Americans Month, so that’s where we celebrate everybody who’s over the age of 65, I guess. So go randomly hug a person who’s over 65. You have our permission.
Smith: You still need consent. Don’t non-consensually attack somebody.
Schenk: No, no. Ask first. And that’s probably going to conclude – hopefully this will conclude this week’s episode of the Nursing Home Abuse Podcast. There are two ways to consume each and every episode. The first way is to watch it either on our YouTube channel or on our website, which is NursingHomeAbusePodcast.com, or you can download the audio wherever you get your podcasts from, iTunes, Stitcher, Spotify, Google, wherever you want. And with that, we will se you next time.
Smith: See you next time.