Empowering Consumers to Prevent Healthcare Fraud
What is healthcare fraud?
Healthcare fraud happens when someone bills your health insurance, including Medicare, for:
- Something you did not receive
- Something different than what you received
- Something that was not medically necessary
Healthcare fraud is very common and occurs in every city, in every state, every day. If fraud happens to you, it is not your fault. Scam artists will do anything to gain our trust, and even the most sensible consumers can get “scammed.”
The best way to detect healthcare fraud is to read you Medicare Summary Notice (MSN) or your insurance’s Explanation of Benefits (EOB).
If you find a claim or charge for something that fits in the categories above, this may be a sign of errors, billing abuse or potential fraud. You can:
- Call the provider to ask about the claim of charge (if you know and trust the provider)
- Or call your local Senior Medicare Patrol (SMP)
If you live in Illinois, call the Illinois SMP at AgeOptions (800)699-9043 (ask for “SMP”). If you live outside of Illinois, find your state’s SMP at www.smpresource.org.
What is the SMP Program?
The Senior Medicare Patrol (SMP) Program empowers consumers to prevent healthcare fraud. With volunteers and program staff, we help people with Medicare and Medicaid to Prevent, Detect, and Report Medicare & Medicaid fraud, waste, and abuse. The Administration for Community Living (ACL) provides funding to SMP programs in all 50 states, Washington, D.C., Puerto Rico, Guam, and the Virgin Islands.
In Illinois, AgeOptions is the statewide Illinois SMP. To find the SMP program in your state, visit the National SMP Resource Center website at www.smpresource.org and use the SMP Locator tool.
What can I do about healthcare fraud?
- Educate Yourself About Fraud - Attend an SMP presentation in your community or read more about healthcare fraud schemes on our SMP Materials page.
- Volunteer with SMP - SMP is a volunteer-centered program. We need volunteers to share information in their communities through presentations, community fairs and more. Find out more about volunteering with the Illinois SMP.
- Spread the Word - Share what you know about healthcare fraud with friends, family and neighbors. You can sign up for our SMP Fraud Alert emails to stay up-to-date on current fraud trends and more.
Is the SMP in my community?
Yes! The Illinois SMP Program is a statewide program. Anyone in Illinois can call our Illinois SMP at AgeOptions hotline at (800)699-9043 (ask for “SMP”).
The Illinois SMP is headquartered at AgeOptions, the Area Agency on Aging for Suburban Cook County, and we work with several other agencies to provide information about healthcare fraud across Illinois. Our statewide partner agencies include the 12 other Illinois Area Agencies on Aging (click here to find the AAA serving your county):
- AgeSmart Community Resources
- Area Agency on Aging for Lincolnland
- Central Illinois Agency on Aging
- Chicago Department of Family and Support Services - Senior Services Area Agency on Aging
- East Central Illinois Area Agency on Aging
- Egyptian Area Agency on Aging
- Midland Area Agency on Aging
- Northeastern Illinois Area Agency on Aging
- Northwestern Illinois Area Agency on Aging
- Southeastern Illinois Agency on Aging
- West Central Illinois Area Agency on Aging
- Western Illinois Area Agency on Aging
In Cook County, we also partner with:
- Catholic Charities of the Archdiocese of Chicago - Northwest Suburban Senior Services
- Catholic Charities of the Archdiocese of Chicago - South Suburban Senior Services
- Coalition of Limited Speaking Elderly (CLESE)
- White Crane Wellness Center
What are the types of fraud that are currently happening in Illinois?
While we take reports of all kinds of healthcare and Medicare fraud, the following are currently our most reported areas of fraud:
All areas of Medicare are subject to fraud. Please visit our SMP Materials page to find out more.
This project was supported, in part by grant number 90MPPG0036, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.