DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of Inspector General
Memorandum
Date:
August 22, 2002 John I. Molnar Regional Inspector General for Evaluation and Inspections – New York Performance Data for the Senior Medicare Patrol Projects: August 2002 Performance Report (OEI-02-02-00560) Edwin Walker, Director Office of Program Operations and Development Administration on Aging
From:
Subject:
To:
At the request of the Administration on Aging (AoA), the Office of Inspector General collects performance data for the Senior Medicare Patrol Projects. The attachments present cumulative performance data from the beginning of each project. Attachment A lists complete data for the 12 projects that have operated since the inception in 1997. Attachment B presents the cumulative 3 years of work for 29 projects. Attachment C reflects performance data for 7 projects with 2 years of experience. And, Attachment D contains the first year of data for 4 new projects. Please note that the project data are self-reported and that we have not independently verified their accuracy. To date, the 52 Senior Medicare Patrol Projects have trained 31,173 volunteers. In-turn, 869,472 beneficiaries have been reached at the 154,710 training sessions conducted by these volunteers. The beneficiaries have reported 19,342 complaints, of which 4,205 have been referred for follow-up. Almost 1,800 resulted in some action. In total, closed complaints have resulted in the recoupment of $3,008,937 in Medicare funds and, reportedly, $76,621,601 to other payors. In the past 6 months, a total of 5,259 volunteers have been trained and 218,504 beneficiaries were educated at the 49,213 training sessions conducted by the volunteers. A total of 4,244 complaints have been logged since our last report. Documentation received in the past 6 months provides evidence of $101,958 in Medicare funds recouped as a direct result of the projects. Another $14,503,878 has been recouped to other payors. Of the 52 grantees, 17 reported savings in the past 6 months. Of these 17 grantees, 11 submitted Centers for Medicare & Medicaid Services contractor-based complaint tracking system reports. In comparison, in March 2002 we reported that four grantees submitted
Page 2 – Edwin Walker tracking system reports. Of the money reported recouped in the past 6 months, $87,116 or 85 percent of the total dollars saved, were documented by the tracking reports. We continue to emphasize that a significant number of the beneficiaries, who have learned to detect fraud, waste and abuse from the Senior Medicare Patrol Projects, are calling the OIG fraud hotline or other contacts, thereby, not giving the projects their full credit. In addition, substantial savings, which cannot be tracked, may be derived from a sentinel effect whereby fraud and errors are reduced in light of Medicare beneficiaries’ scrutiny of their bills. At this time, we encourage AoA to develop a strategy to continue monitoring the Senior Medicare Patrol Projects. We are fully prepared to work with AoA to develop and implement that strategy. If you have any questions, please call me at 212-264-2000. Attachments
APPENDIX A
60-Month Outcomes Reported by the Senior Medicare Patrol Projects
Activity
OUTPUTS # training sessions # trainers trained # media events # community education events OUTCOMES total # trainers who have ever conducted activities # group sessions # beneficiaries at group sessions # one -on-one sessions total # beneficiaries educated estimated # people reached by community education events # complaints received # complaints referred for follow -up # complaints resulting in some action Medicare $ recouped Other $ recouped Total $ recouped 1,388 19,897 21,614 5,019 92 2,024 204 56 44 266 4,236 63 192 2,312 2,367 670 24 253 1,292 316 228 2,182 259 1,319 84 533 452 707 36 167 65 204 16 613 1,090 190 524 10,250 376 902 63 207 60 319 11 249 7,152 75 74 841 4,061 198
TOTAL
CA
HI
IA
IL
MD
MN
MO
NH
NY
PA
RI
WI
5,627 8,878 350,890 44,036 394,926
374 1,552 68,764 679 69,443
138 301 10,520 0 10,520
DK 1,306 41,267 216 41,483
244 1,345 50,313 487 50,800
106 990 21,304 9,315 30,619
237 685 13,913 567 14,480
167 178 7,978 9,109 17,087
519 413 28,451 16,503 44,954
3,493 854 29,852 6,588 36,440
143 600 60,622 375 60,997
23 256 5,633 DK 5,633
183 398 12,273 197 12,470
9,088,192 10,635
31,678 745
17,814 111
313,165 1,043
16,901 313
80,164 1,303
25,178 339
246,305 35
42,745 4,774
258,287 734
8,010,022 988
23,123 47
22,810 203
1,744
240
39
388
91
236
155
33
104
228
99
37
94
616 $2,763,570 $76,021,924 $78,785,494
44 $1,318,913 $74,914 $1,393,827
DK
41
10 $0 $146,485 $146,485
104 DK DK $0
62 $109,997
8 $132
38 $107
219 $31,038
40 $144,339 $1,935 $146,274
6 $0 $0 $0
44 $11,520 $14,450 $25,970
DK $1,147,524 DK $1,324,867 $0 $2,472,391
$27,956 $1,155,471 $137,953 $1,155,603
$74,646 $73,201,200 $74,753 $73,232,238
APPENDIX B
36-Month Outcomes Reported by the Senior Medicare Patrol Projects
Activity
OUTPUTS # training sessions # trainers trained # media events # community education events OUTCOMES total # trainers who have ever conducted activities # group sessions # beneficiaries at group sessions # one -on-one sessions total # beneficiaries educated estimated # people reached by community education events 2,212,903 # complaints received # complaints referred for follow -up # complaints resulting in some action Medicare $ recouped Other $ recouped Total $ recouped Please note these distinctions: 1. The AARP Foundation, DC 8,079 25,196 443 37,791 140 9,673 50 37,172 13,078 1,965 115 16,347 76 185,900 310 69,837 0 129,963 118 147,234 536 4,200 1,035,260 10 28 7,074 1,207 13,536 7 1,993 8,890 15,295 6,786 50 112 44 51 62 292 105 235 12 129 35 91 38 115 482 310 29 200 36 421 14 167 804 602 12 57 32 40 21 14 22 0 28 221 4,697 101 19 136 955 136 40 681 35 24 256 1,541 1,001 1,462 160 462 1,569 167 13 205 40 83
TOTAL
AK
AL
AR
AZ
CO
CT
DC1
DC2
DE
FL
GA3
GA4
ID
IN
4,070 8,716
83 32
389 342
43 92
115 285
30 382
26 113
79 165
32 91
79 294
96 163
199 321
655 1,782
137 594
21 44
359,592 85,825 445,417
1,082 2,290 3,372
14,214 354 14,568
8,787 51 8,838
26,586 222 26,808
10,342 151 10,493
3,590 232 3,822
5,374 10 5,384
3,321 744 4,065
7,515 94 7,609
10,210 455 10,665
9,495 539 10,034
53,743 555 54,298
33,624 435 34,059
1,462 36 1,498
2,326
22
65
14
143
16
31
53
0
20
17
5
18
564
7
1,110 $224,982 $586,306 $811,288
7 $0 $13,495 $13,495
5 $0 $0 $0
DK DK DK $0
22 $429 $3,271 $3,700
DK $453 $3,450 $3,903
3 $29,446 $0 $29,446
9 $1,329 $0 $1,329
0 $0 $0 $0
1 $5,388 $0 $5,388
5 $4,511 $53,190 $57,701
0 $0 $0 $0
4 $0
293 $10,970
0 $0 $0 $0
$0 $266,797 $0 $277,767
2. Friendship House, DC
3. Atlanta Regional Commission, GA
4. Department of Human Resources, GA
APPENDIX B
36-Month Outcomes Reported by the Senior Medicare Patrol Projects
Activity
OUTPUTS # training sessions # trainers trained # media events # community education events OUTCOMES total # trainers who have ever conducted activities # group sessions # beneficiaries at group sessions # one -on-one sessions total # beneficiaries educated estimated # people reached by community education events # complaints received # complaints referred for follow -up # complaints resulting in some action Medicare $ recouped Other $ recouped Total $ recouped Please note these distinctions: 5. Baylor University, TX 68 211 194 184 59 219 130 358 34 515 4 61 17 65 2,588 139 17 383 207 216 54 122 66 84 6 113 99 132 9 98 36 218 69 602 262 63 24 307 127 520 18 244 213 135 60 463 100 240 31 139 37 116 31 550 356 356 763 520 1,027 219
MA
ME
MI
MT
NM
NV
OH
OK
OR
PR
TX5
TX6
UT
VA
WA
109 271
133 223
70 155
76 102
65 79
86 73
45 304
22 31
177 157
25 274
260 72
223 381
111 113
164 783
520 998
9,859 2,426 12,285
5,558 421 5,979
10,787 22 10,809
2,032 101 2,133
5,818 3,148 8,966
6,617 41 6,658
9,449 1,417 10,866
5,709 13 5,722
15,472 249 15,721
5,698 2,257 7,955
1,375 255 1,630
12,160 788 12,948
4,198 1,913 6,111
27,356 DK 27,356
48,159 66,606 114,765
15,871 197
19,182 66
3,886 183
2,843 95
33,679 159
14,278 245
28,081 39
37,001 59
14,028 59
17,291 1,450
8,249 51
29,346 115
22,050 61
137,521 229
97,336 66
53
41
63
7
49
32
21
25
18
748
16
55
23
174
26
DK DK $51,949 $51,949
16 DK DK $0
N/A $17,320 $15,626 $32,946
0 $0
116 $5,263
2 $787 $3,723 $4,510
1 $395 $0 $395
0 $0 $0 $0
5 DK DK $0
541 $4,968 DK $4,968
13 $0 $0 $0
27 $2,516 $86 $2,602
2 $0 $4,485 $4,485
15
23
$19,935 $121,272 DK $13,262
$1,079 $155,893 $1,079 $161,155
$19,935 $134,534
6. The National Hispanic Council on Aging, TX
APPENDIX C
24-Month Outcomes Reported by the Senior Medicare Patrol Projects
Activity
OUTPUTS # training sessions # trainers trained # media events # community education events OUTCOMES total # trainers who have ever conducted activities # group sessions # bene ficiaries at group sessions # one -on-one sessions total # beneficiaries educated estimated # people reached by community education events 99,802 # complaints received # complaints referred for follow -up # complaints resulting in some action Medicare $ recouped Other $ recouped Total $ recouped 607 2,751 41 11,074 354 25,493 103 46,357 20 5,960 43 2,242 7 5,925 39 265 2,117 872 535 11 110 36 38 22 217 43 130 190 1,078 72 226 27 390 664 45 9 115 8 29 2 81 26 18 4 126 23 49
TOTAL
LA
MS
NC
NE
SC
SD
WY
544 607 16,915 6,152 23,067
47 83 1,293 181 1,474
104 182 5,188 5,215 10,403
102 105 2,125 360 2,485
233 116 4,304 264 4,568
22 22 840 55 895
14 40 1,028 8 1,036
22 59 2,137 69 2,206
129
7
16
28
11
38
2
27
66 $20,204 $13,325 $33,529
3 $0 $0 $0
0 0 $0 $0
17 140 $108 $248
1 0 $0 $0
21 7,274 $0 $7,274
1 0 $0 $0
23 12,790 $13,217 $26,007
APPENDIX D
12-Month Outcomes Reported by the Senior Medicare Patrol Projects
Activity
OUTPUTS # training sessions # trainers trained # media events # community education events OUTCOMES total # trainers who have ever conducted activities # group sessions # beneficiaries at group sessions # one -on-one sessions total # beneficiaries educated estimated # people reached by community education events # complaints received # complaints referred for follow -up # complaints resulting in some action Medicare $ recouped Other $ recouped Total $ recouped 87 269 303 445 46 97 146 86 2 16 4 1 39 156 143 40 0 0 10 318
TOTAL
KY
NJ
TN
WV
205 228 5,794 268 6,062
175 176 4,459 128 4,587
6 9 206 5 211
24 43 1,129 135 1,264
0 0 0 0 0
50,224 21
46,707 1
1,000 3
2,199 17
318 0
6
1
3
2
0
3 $181 $46 $227
0 $0 $0 $0
3 $181 $0 $181
0 $0 $46 $46
0 $0 $0 $0