Early last year, Medicare saw one of the largest COVID-19 fraud schemes targeting Medicare beneficiaries. When traces of the scheme were detected in Iowa, the Iowa Insurance Division sent letters to SHIIP-SMP clients alerting them of symptoms of the Medicare scam hitting their accounts: receiving COVID test kits in the mail that they never ordered, or never receiving any kits at all, but seeing charges for the kits on their Medicare statements.
By mid-April, the Iowa’s SHIIP-SMP State Office was inundated with complaints from clients who had been affected by the nationwide fraud scheme.
The Senior Medicare Patrol (SMP) assists beneficiaries and their caregivers to prevent, detect, and report Medicare fraud, errors, and abuse. In the Spring of 2023, five certified SHIIP Medicare volunteer counselors completed eight weeks of training and mentorship to become SMP specialists and assist the State with reporting suspected Medicare fraud, errors and abuse to the Office of the Inspector General (OIG), the Federal entity responsible for investigating health care fraud in the United States.
One SMP Specialist in Iowa helped CMS make an astounding discovery. Elaine Edward’s assistance in working with beneficiaries to collect information revealed the largest number of providers submitting suspected fraudulent Medicare claims on one single Medicare beneficiary’s account, with a total of 15 claims dating from 11/2022 to 5/2023, from 12 different providers.
Edwards has served as a SHIIP Medicare counselor since 2005 and is one of the leading SMP volunteers in the nation. “Elaine has not only offered SMP education during 100+ client contacts, she has also assisted on over 40 reports submitted for investigation to the OIG,” says Marlú Abarca, SMP Coordinator. About her SMP casework, Edwards herself has stated, “It’s been fun and interesting and [I’m] looking forward to learning more [about Medicare fraud].” It is estimated that the muti-year, national COVID-19 Medicare fraud scheme cost Medicare beneficiaries and taxpayers over $490 million.
For more information on how to prevent, detect, and report Medicare fraud, errors, and abuse, please visit the Protect Yourself page on this website.