The Illinois Senior Medicare Patrol (SMP) Program

Have you ever gotten a phone call from someone who said they were “from Medicare,” but to send you a new Medicare card, they need your Medicare number?

Have you ever seen something listed on your Medicare Summary Notice that you didn’t receive?

Have you had an insurance agent sign you up for an insurance plan without your permission?

If any of these have happened to you, you have experienced healthcare fraud. If you suspect fraud, please remember:

1) Healthcare fraud is not your fault. Fraud occurs in every city, in every state, every day. Scam artists will do anything to gain our trust, and even the most sensible consumers can get 'scammed.'

2) You CAN do something about it – you can report it to the Illinois SMP (Senior Medicare Patrol) Program!

What is the SMP Program?

The SMP (Senior Medicare Patrol) Program empowers consumers to prevent healthcare fraud. Program staff and volunteers help people with Medicare and Medicaid to:

1) PROTECT themselves from Medicare & Medicaid fraud, waste, and abuse.
2) DETECT Medicare & Medicaid fraud, waste, and abuse.
3) REPORT Medicare & Medicaid fraud, waste, and abuse.

The Administration on Aging provides funding to SMP programs in all 50 states; Washington, D.C.; Puerto Rico; Guam; and the Virgin Islands. The Illinois SMP Program is located at AgeOptions, the Area Agency on Aging for Suburban Cook County.

AgeOptions works with several other agencies to provide information about healthcare fraud in Illinois. These agencies are: Illinois Area Agencies on Aging, Catholic Charities, Senior Services Associates, the Coalition of Limited English Speaking Elderly, and the Illinois Network of Centers for Independent Living.

SMP Partners and their Contact Information

For help finding your state’s SMP program, call AgeOptions at (800)699-9043 (Voice) or (708)524-1653 (TTY).

What is Healthcare Fraud?

Healthcare Fraud, waste, and abuse occur in all parts of the healthcare industry. Here are some examples:

• A home health agency bills Medicare for services that you never received.

• A medical equipment company bills Medicaid for a wheelchair that you didn’t need.

• A hospital purposely uses the wrong code for a lab test so they can get paid more.

• A podiatrist visits a senior apartment building. He offers to trim everyone’s toenails, as long as they give him their Medicare numbers. He uses the residents’ Medicare numbers to bill Medicare for foot surgery.

• A doctor offers his patients money or gifts if they come to him for services.

• An insurance agent signs someone up for an insurance plan without her permission.

• An insurance agent lies to people about an insurance plan’s coverage to get them to join.
  

How Does the SMP Program Help Stop Healthcare Fraud?

To help consumers stop fraud, SMP staff and volunteers:

• Give presentations on healthcare fraud to groups
• Provide information on healthcare fraud at community events
• Help people report fraud when it occurs

If you would like to request a presentation on healthcare fraud, contact AgeOptions or call your nearest SMP partner agency.

SMP Partner Agencies and their Contact Information

What Can You Do?

You can follow these 3 steps: PROTECT, DETECT, REPORT!

1) PROTECT your personal information.

• Treat your Medicare and Medicaid numbers like credit card numbers. Don’t give them out to someone you don’t know, especially if the person is on the phone or at your door.
• DON’T carry your Social Security, Medicare, or Medicaid cards in your wallet, unless you are going somewhere to get health services. If you really want to have a copy of your Medicare card in case of emergency, make a photocopy of your card and carefully black out most of your Social Security number. Remember, though -- you should not need to show your Medicare card to receive emergency care.
• Keep your Medicare Summary Notices and other billing statements in a safe place. Shred them before you throw them away!
• Don’t leave mail in your mailbox for more than 1 day.

More Tips on How to Protect Yourself from Healthcare Fraud!

2) DETECT fraud, waste, and abuse by reading your Medicare Summary Notice or Explanation of Benefits. Watch for:

• Services or supplies you didn’t receive
• Services or supplies your doctor didn’t order
• Services or supplies not related to your condition
• Billing for the same thing twice

Keep track of your doctor appointments and other health services. Use your notes to check your Medicare Summary Notice for errors.

Call AgeOptions at (800)699-9043 (Voice) or (708)524-1653 (TTY) for a FREE healthcare tracking journal!

How to Read your Medicare Summary Notice for Part A (hospital) claims

How to Read your Medicare Summary Notice for Part B (doctor) claims

3) REPORT any fraud, waste, or abuse that you find!

• Call the doctor or other provider who sent the bill to Medicare. If the problem is just an error, they can fix it.

• If this doesn’t work or you still suspect fraud, call AgeOptions at (800)699-9043 (Voice) or (708)524-1653 (TTY).

Volunteer with the SMP Program!

The Illinois SMP Program needs volunteers to help give presentations, distribute information at community events, and help counsel others about fraud and abuse. All interested individuals are welcome! No experience is needed – we train and support all of our volunteers.

To find out more about volunteering with SMP, contact AgeOptions at (800)699-9043 (Voice) or (708)524-1653 (TTY).

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