Is the Senior Medicare Patrol a Good Investment?


Return on investment is one of the most important business metrics out there, and a poor ROI often spells the end of a project. Whether that holds true for the public sector remains to be seen after the recent release of a report focused on Senior Medicare Patrol results for 2016. The program received $18 million in federal funding last year, but only resulted in $2,672 in improper payment recoveries, compared with $2.5 million in recoveries in 2015.

SMP programs are active in all 50 states as well as the District of Columbia, Puerto Rico, and Guam. They involve Medicare beneficiaries who help identify and deter fraud and educate other beneficiaries about identifying fraud.

Linda Baumann, a health-care attorney with Arent Fox in Washington, told me that the drop-off might be due to a switch in methodology that happened last year, and may only be a temporary blip.

“If the numbers stay this low next year, there may be some further evaluation or modification of the SMP program, but there were no recommendations in the report so it's unlikely any further action will be taken at this time,” Baumann said.

The methodology change involved reducing the number of performance measures from 21 to 10. The five measures associated with recoveries, savings, and cost avoidance were kept, while the remaining measures associated with volunteering and outreach efforts were reduced to five new measures.

On the bright side, SMP programs boosted cost avoidance for Medicare beneficiaries from $21,533 in 2015 to $163,904 in 2016, and increased savings to beneficiaries to $53,449, up from $35,059.

You can read my full story here.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

Learn more about Bloomberg Law and sign up for a free trial.