SMP Foundations Training Manual CHAPTER 1 ... - SMPresource.org

SMP Foundations 

Training Manual 

CHAPTER 1: SMP Program 

Training Goal and Objectives ................................................... 1 

Background ............................................................................... 2 

National SMP Program Overview ............................................. 3 

The Role of SMPs ............................................................... 4 

SMP Strategic Program Objectives ..................................... 4 

Program Accountability ....................................................... 6 

SMP Volunteers .................................................................. 8

SMP FOUNDATIONS TRAINING MANUAL 

CHAPTER 1: SMP Program 

This chapter provides an overview of the Senior Medicare Patrol (SMP) program. 

Training Goal and Objectives 

Goal: SMP Foundations Training 

The goal of SMP Foundations Training is to provide volunteers with a foundation of 

knowledge in three main content areas: 

1. SMP Program 

2. Medicare Basics 

3. Medicare Fraud and Abuse 

Objectives: Chapter 1 

Upon completion of Chapter 1: SMP Program, you will be able to: 

1. Describe the background of the national SMP program 

2. Identify the three roles of SMPs 

3. List and explain the U.S. Administration on Aging’s SMP Strategic Program 

Objectives 

4. Describe the basic components of SMP program accountability and reporting 

5. Name the database used to track SMP activity and list ways that volunteers might 

interact with this database 

KEY 

TERMS 

SMP: This is the acronym for Senior Medicare Patrol. 

SMP Foundations Training Manual May 2011 

Chapter 1 – Page 1


Background 

The Department of Health and Human Services’ (HHS) Office of Inspector General 

(OIG) estimates that the Medicare program loses billions of dollars each year due to 

errors, fraud, and abuse. 

This problem affects all Americans. It affects beneficiaries by wasting Medicare 

money that could be used to increase and improve health care services. And, it 

affects everyone who pays taxes by wasting billions of tax dollars. 

While the vast majority of health care providers are honest, those operating 

unscrupulously—intent on obtaining precious health care dollars illegally—have done 

so based on the notion that the risks of being detected have lessened over the years. 

In 1997, through the Omnibus Consolidated Appropriation Act of 1997 (Public Law 

104-208), the U.S. Administration on Aging (AoA) established 12 grant-funded 

demonstration projects. These projects were designed to recruit and train retired 

professionals, such as doctors, nurses, teachers, lawyers, accountants, and others to 

identify and report error, fraud, and abuse. 

The Senate report (Senate Report 104-368) on the appropriations bill noted that 

“senior citizens are also our best front line defense against these losses. Yet often 

they don't have the information and expertise needed…” to recognize and accurately 

report cases of error, fraud, and abuse. 

Medicare is more than a health care program. 

It’s a promise from one generation of Americans to another. 

Keeping the promise is everyone’s responsibility. 

KEY 

TERMS 

Office of Inspector General (OIG): The HHS (Department of 

Health and Human Services) agency that is responsible for the 

investigation of suspected fraud and abuse and performing audits and 

inspections of HHS programs. The OIG has authority to levy certain 

sanctions and Civil Monetary Penalties. 

U.S. Administration on Aging (AoA): The HHS agency that is a 

focal point and advocacy agency for older persons and their concerns 

at the Federal level. AoA works closely with its nationwide network of 

State and Area Agencies on Aging (AAA) to plan, coordinate, and 

develop community-level systems of services that meet the unique 

needs of individual older persons and their caregivers. 




National SMP Program Overview 

Since its inception in 1997, the SMP 

program has evolved from a handful of 

diverse demonstration projects to a 

nationwide program. The SMP 

program includes projects in all 50 

states, the District of Columbia, Puerto 

Rico, Guam, and the U.S. Virgin 

Islands. 

Every three years AoA develops a 

new request for proposals for the SMP 

program and then competitively 

awards grants to projects that are 

selected. Funding for the program is 

provided by a grant from AoA. In addition, each project is required to provide 

“matching” contributions of a certain amount. Even though the program has been 

around for more than a decade, it is still not considered a permanent program. 

The goal of the SMP program is to empower seniors to 

prevent health care fraud through outreach and education. 

SMPs have made great progress in recruiting and training retired professionals and 

other senior citizens about Medicare and Medicaid error, fraud, and abuse. 

These volunteers work in their communities, senior centers, and elsewhere to 

educate Medicare and Medicaid beneficiaries, family members, and caregivers to 

actively protect themselves against health care fraud, waste, and abuse by reviewing 

their Medicare Summary Notices (MSNs) to detect and report suspected errors. 

KEY 

TERMS 

Medicaid: A joint Federal and State program that helps with medical 

costs of people with low incomes and limited resources. Medicaid 

programs vary from state to state, but most health care costs are 

covered if you qualify for both Medicare and Medicaid. 

Medicare: The Federal insurance program for people 65 years of age 

and older and certain younger people with disabilities, and people with 

End-Stage Renal Disease (permanent kidney failure with dialysis or a 

transplant, abbreviated ESRD) or Amyotrophic Lateral Sclerosis (ALS). 

Medicare Summary Notices (MSNs): The notices you get after the 

doctor or provider files a claim for Part A or Part B services in original 

Medicare. It explains what the provider billed for, the Medicare-approved 

amount, how much Medicare paid, and what you may be billed. 




National SMP Program Overview, continued 

The Role of SMPs 

The role of the Senior Medicare Patrol program is to: 

1. Disseminate SMP fraud prevention and identification information through the 

media, outreach campaigns, community events, and many other means. 

2. Assist beneficiaries in resolving potential fraud-related inquiries and issues 

regarding Medicare, Medicaid, and other health care or related consumer issues. 

3. Make referrals of suspected cases of 

fraud, waste, or abuse to appropriate 

investigative entities, such as: 

Medicare contractors 

 

 

 

 

State Medicaid Fraud Control 

Units (MFCU) 

State Attorneys General (AG) 

Department of Health and 

Human Services’ Office of 

Inspector General (OIG) 

Centers for Medicare & Medicaid 

Services (CMS) 

SMP Strategic Program Objectives 

The SMP Message: 

Protect, Detect, Report 

SMPs provide seniors with 

information to: 

PROTECT themselves from 

Medicare errors, fraud and abuse; 

DETECT potential errors, fraud 

and abuse; and 

REPORT their concerns. 

This message of “protect, detect, 

report” is a core part of the SMP 

program and is reviewed in greater 

detail in chapter 3. 

AoA regularly works in conjunction with state SMP programs to develop and refine 

national program objectives. These objectives provide guidance and direction to the 

local SMP programs. As part of the grant-seeking process, potential SMPs must 

develop a set of activities that are designed to meet the needs of local communities 

while contributing to a set of national program objectives. 

The current SMP Strategic Program Objectives are to: 

 

 

Foster National and Statewide Program Coverage: Statewide program 

coverage is defined as service to each county within the state, each ward in the 

District of Columbia, or jurisdiction in the territories. 

Improve beneficiary education and inquiry resolution: Each SMP is required 

to implement a plan for increasing the number of beneficiaries educated about 

health care fraud through expansion of their volunteer capacity. This objective 

includes specific requirements for recruiting, screening and training senior 

volunteers. 




National SMP Program Overview, SMP Strategic Program Objectives, continued 

 

 

Foster national program visibility and consistency: SMPs are required to 

assess the risk in their volunteer programs as well as implement programs for 

adequately screening new volunteers. In addition, every program must utilize 

SMART FACTS, the SMP data management system, to accurately record and 

report performance measures in a timely manner. 

Improve the efficiency of the SMP program while increasing results for both 

operational and quality measures: At a minimum, SMP programs are required 

to track and increase the following: 

1. Volunteer involvement, including the number of volunteers and the hours 

contributed by volunteers 

2. The number of beneficiaries educated by group and one-on-one sessions 

3. The number of simple inquiries and complex issues addressed 

4. Medicare, Medicaid, or other savings achieved or referred for further action as 

a result of program efforts 

Target training and education to isolated and hard-to-reach populations: 

The Older Americans Act (OAA) requires that program services target lowincome, 

vulnerable populations that are traditionally underserved due to isolation; 

ethnic, cultural, language barriers; or other factors. SMPs must identify specific 

target populations within their state, and provide a plan to reach these special 

populations. The OAA is the federal law that created services, opportunities, and 

protections for older Americans. 

SMP Resource Center 

One of the resources available to SMP programs is the 

National Consumer Protection Technical Resource Center, 

also known as the SMP Resource Center, or simply The Center. 

Funded by AoA, The Center provides training and technical support 

including mentoring of new projects, disseminating best practices 

and innovations, technical assistance, training, and support of 

SMP project implementation and effective use of AoA’s data management 

tracking and reporting system (called SMART FACTS). 

The Center website for SMP Resources is www.smpresource.org. 




National SMP Program Overview, continued 

Program Accountability 

As a government-funded initiative, the 

SMP program is accountable for 

documenting and reporting on 

program activities and outcomes to a 

number of entities. 

Semiannually, the OIG collects and 

analyzes data submitted by SMP 

programs on the activities and 

performance results of the program. 

SMPs use an online database known 

as SMART FACTS for capturing and reporting data to the OIG. 

SMART FACTS allows SMPs to track and report on the following activities: 

1. Information related to the receipt, resolution, and/or referral of complex issues and 

complaints of health care fraud, errors, or abuse 

2. Outreach and education activities 

3. Volunteer time and effort 

KEY 

TERMS 

SMART FACTS: The Seniors Medicare Assistance and Reporting Tool for 

Fraud And Complaint Tracking System. SMART FACTS is the web-based 

electronic tool for SMP management, tracking, and reporting of program 

outcomes to AoA and to the Office of the Inspector General (OIG). 

Complex Issue: The OIG performance measure definition of a complex issue 

is: “Inquiries that generally require the SMP staff or volunteer to obtain 

beneficiary personal identifying information and detailed information related to 

the issue, complaint, or allegation in order to conduct further investigation or 

referral.” Complaints, defined by the OIG as allegations of errors, fraud, and 

abuse, are one type of complex issue. 




National SMP Program Overview, Program Accountability, continued 

Some volunteers interact directly with SMART FACTS, while others use reporting 

forms to submit their data for someone else to enter in SMART FACTS. 

As a volunteer, you may interact with SMART FACTS in one or more of the following 

ways: 

1. Completing and submitting timesheets and activity reports, which are then entered 

into SMART FACTS and reported as part of the OIG Performance Measures 

2. Utilizing a reporting form to submit information about simple inquiries 

3. Submitting information about community Outreach & Education activities that is 

then reported as part of the OIG Performance Measures 

4. Entering data on activities and reporting forms into SMART FACTS 

5. Accessing the SMART FACTS’ Complex Issues module to refer an allegation of 

fraud and abuse to an investigative entity 

There is an extensive SMART FACTS training manual and set of resources which are 

available in the event you require more information and training on SMART FACTS. 

Your SMP program director will provide information on specific SMART FACTS 

reporting and training requirements. 

What’s with all the paperwork 

You might wonder why there is so much emphasis on timesheets, 

activities, and reports being turned in to your program. To continue 

receiving funding, SMPs are required to report detailed information on 

their activities to the OIG and AoA. From there, reports about 

volunteer activities go on to Congress, where the buck literally stops. 

Since 1997, the SMP program has reported performance data to AoA and the OIG. 

This data provides useful tracking information on SMP progress; however, as the 

SMPs and the OIG readily acknowledge, it doesn’t always paint a complete picture of 

the work done by the SMPs. 




National SMP Program Overview, Program Accountability, continued 

Although beneficiaries may learn about how to detect fraud, waste, and abuse from 

an SMP project’s outreach and education activities, they don’t necessarily follow up 

directly with the SMP regarding their results. It’s important to understand that there 

are many successes of the SMPs that are not included in their performance data. 

For example: 

Beneficiaries might call the OIG fraud hotline or other contacts to report an 

incident of suspected fraud. 

 

Beneficiaries may achieve substantial cost savings by reviewing their MSN and 

medical bills using the information learned from the SMPs, and follow up on their 

own to resolve errors or abuse. 

Even though SMP reporting results are not all-inclusive, the data about program 

activities and outcomes that the SMPs are able to capture is very important. This 

data allows the SMPs to “tell the story” of what they have accomplished, the people 

they have helped, and the money that has been recouped for beneficiaries and the 

Medicare and Medicaid programs. 

SMP Volunteers 

The number of retired people is growing fast. Most take comfort in knowing that the 

Medicare program will be there to provide health care coverage as they age. 

Due to the unscrupulous practices of a small number of people, Medicare and 

Medicaid are being drained of billions of dollars of valuable resources that 

beneficiaries rely on when it comes to their health and the health of their loved ones. 

The SMP program provides an opportunity for seniors to step up and make an impact 

in the fight against fraud. The dedicated corps of SMP volunteers makes a difference. 

SMP programs seek volunteers whose skills, abilities, and personal goals are 

compatible with the goals and mission of the program. 

"I wouldn't be alive if it wasn't for Medicare. I owe Medicare something 

in order to keep it going so someone else can use it like I had to…. 

I want other people to have the option of living 24 more years if they want." 

Mrs. Dottie Lund, 

a speaker to senior groups in Wisconsin who has assisted with outreach since 2001 




National SMP Program Overview, SMP Volunteers, continued 

One of the main goals of the SMP program is to develop a corps of senior volunteers 

and professionals that can help their peers become better health care consumers. 

Most SMP programs also provide opportunities for civic-minded individuals not yet 

eligible for Medicare who have the time and interest. 

Volunteers are a valuable resource to the SMP program, the agency you work with, 

its staff, and its clients. 

According to data captured in SMART FACTS, in 2010 alone: 

4,964 volunteers served SMP programs. 

Volunteers received 53,878 hours of training and contributed 129,662 work hours 

in support of the SMP program. 

With the help of volunteers, SMPs across the country: 

• Educated 298,097 beneficiaries in 8,300 group education sessions 

• Held 70,789 one-on-one counseling sessions 

• Conducted 51,885 media airings 

• Reached 1,469,785 people in 6,231 community outreach education events 

• Received 91,094 simple inquiries 

• Received 2,273 complex issues 

40% of these, with an estimated dollar value of over $1.48 million, 

were referred to other entities for further action. 

73% of complex issues were resolved. 

Since the program’s inception through 2010, 

SMP project efforts have resulted in: 

82,968 group education sessions 

Over 1.1 million one-on-one counseling sessions convened 

1,321,222 media airings 

Over 25.3 million people reached during community education events 

261,878 simple inquiries received 

27,008 complex issues received 

Almost $106 million in documented savings directly attributable to SMP projects

SMP Foundations Training Manual CHAPTER 1 ... - SMPresource.org

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