Iowa Senior Medicare Patrol (SMP) is a program that empowers and assists to prevent, detect and report health care fraud, errors and abuse.
Elderbridge has specially trained volunteers and staff to reach out to Medicare and Medicaid beneficiaries, their families, and caregivers through counseling and education to answer your questions.
To schedule an SMP presentation or to become an SMP volunteer in your area please call the Elderbridge SMP Coordinator at 1-800-243-0678 Extension 7079.
What is Healthcare Fraud, Errors or Abuse?
ERRORS are unintentional mistakes that may be corrected. Providing and billing for health care services involves a lot of complicated steps, which may lead to errors or other situations that may not be fraud. Most Medicare payment errors are simply mistakes and are not the result of physicians, providers, or suppliers trying to take advantage of the Medicare system. SMP has reached more than 27 million beneficiaries, empowering them to detect and report billing errors.
ABUSE is defined as incidents or practices of providers that are inconsistent with accepted sound medical, business, or fiscal practices. These practices result in unnecessary costs to the program, improper payments, payment for services that fail to meet professionally recognized standards of care, or conducting procedures that are medically unnecessary.
FRAUD is defined as knowingly and willfully executing, or attempting to execute, a scheme or ploy to defraud the Medicare program, or obtaining information by means of false pretenses, deception, or misrepresentation in order to receive inappropriate payment from the Medicare program. SMP helps recover millions of dollars lost each year to health care fraud.
How Can You Help Prevent Healthcare Fraud, Errors or Abuse?
PREVENT: Don't become a victim of health care fraud or identity theft. Protect your Medicare and Social Security numbers. Don't carry your cards unless you know you will need them that day. Don't give out your numbers to anyone who comes to your door or calls you unexpectedly. Medicare representatives do not call or solicit door-to-door.
DETECT: Look for mistakes or potential fraud in Medicare payments such as:
- Something billed twice
- A service you did not receive
- A medical provider you didn’t see or who wasn’t involved in your care
Most Medicare audits are done after payment is made to the medical provider. By reading your Medicare Summary Notice you are in the best position to identify and report errors early.
REPORT: Begin by asking your doctor, clinic or hospital to explain the Medicare payment showing on your Medicare Summary Notice. Don’t be shy to ask; you pay for your Medicare coverage and you want the payments to be right! If you aren’t satisfied with the assistance you receive, contact SMP at Elderbridge for help at 1-800-243-0678.
Second, Help Protect Your Friends and Neighbors. You can volunteer to become a trained Senior Medicare Patrol member and help spread the word. Call the Elderbridge SMP
staff at 800-243-0678 Extension 7079 for more information.
“This project was supported, in part by grant # 90SP0064-01-00, from the U.S. Admin. for Community Living/Admin. on Aging, Dept. of Health & Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions Points of view or opinions do not, therefore, necessarily represent official Admin. on Aging policy.”