Iowa Insurance Division Is Now Home to Senior Medicare Patrol

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Medicare fraud is a serious, nationwide epidemic. The U.S. General Accounting Office estimates more than $50 billion was lost to Medicare fraud in 2017. Iowans now have one state resource for Medicare education and Medicare fraud reporting.

Iowa SHIIP, Iowa SMP, Kris Gross, Senior Health Insurance Information Program, Senior Medicare Patrol, Medicare Fraud

Kris Gross, Iowa SHIIP and SMP Director

We all should be very concerned and properly educated on how to stop and report Medicare fraud. We can play a big part in preserving the Medicare system for future generations.

Iowa Insurance Commissioner Doug Ommen announced today that the Iowa Insurance Division (IID) is now home to the Senior Medicare Patrol (SMP), a statewide resource for Iowans to report Medicare fraud.

Senior Medicare Patrols (SMPs) empower and assist Medicare beneficiaries, their families and caregivers to prevent, detect and report healthcare fraud, errors and abuse through outreach, counseling and education. SMPs are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).

“Considering the Iowa Insurance Division also presents the statewide Iowa Fraud Fighters education outreach program and has been the home to SHIIP since 1990, our Division was the natural fit to administer the SMP program,” said Commissioner Ommen. “SHIIP has 350 volunteer counselors across the state helping thousands of Iowans navigate the complexities of Medicare, saving them $26 million in Part D plans in 2017. It made sense for the Iowa Insurance Division to be the one state resource for all things Medicare and for Kris Gross, Iowa’s SHIIP director, to oversee the SMP Medicare fraud program too.”

The U.S. General Accounting Office estimates that $1 of every $7 spent on Medicare is paid inappropriately due to errors, fraud and abuse. That added up to $50 billion lost to Medicare fraud nationwide in 2017.

“We work one-on-one with Iowa Medicare beneficiaries, and their caregivers or family members, to review billing information for suspected fraud or errors,” said Gross. “If a healthcare billing error is involved, we provide one-on-one counseling to help correct the error. If we determine fraud or abuse is possible, SMP makes a referral to the appropriate state and federal agencies to investigate.”

Almost 2 million Americans are served nationally by the SMP program's outreach and education efforts.

“Our SHIIP volunteers are such wonderful resources for our state, allowing Iowans to receive free, unbiased and confidential assistance to find the best Medicare plan for their personal medical needs,” said Gross. “All of our SHIIP volunteer counselors are now trained on the SMP program and can assist Iowans to prevent, detect and report Medicare fraud or errors.”            

Gross said it is important to always carefully review medical bills, explanation of benefits statements and Medicare summary notices. She recommends healthcare consumers double-check invoices for unexpected or unexplained charges for medical services, prescription drugs, supplies or equipment.

“Things to look out for include duplicate payments for the same service, an inaccurate medical service date or billings for medical equipment your doctor did not order,” said Gross. “We highly recommend you keep a medical journal and all your medical receipts in an envelope. Compare your journal to the Medicare summary notice, a document that shows what Medicare has paid on your behalf. These summary notices can be challenging to read and understand, so don’t hesitate to contact a SHIIP/SMP counselor for help.”

As an identity theft prevention measure, Gross noted that Medicare distributed new cards this year that no longer include the Medicare beneficiaries’, or their spouses', Social Security number. She said it is still important to protect your Medicare card just like you do your bank card and to know the tips to protect yourself and the government against Medicare fraud.

“Be suspicious of anyone offering free medical equipment or services by requesting your Medicare number and suggesting they can help you get around Medicare rules,” said Gross. “If someone calls you and asks for your Medicare card number and personal information, just hang up the phone. Remember, Medicare already knows your number and won’t randomly call you and ask you for that number.”

Two red flags a Medicare card has been stolen include Medicare denying a service because the beneficiary supposedly already used the benefit, or a debt collector calls for payment on a service the beneficiary did not receive. Gross said it is important to report the possible theft or loss of a Medicare card to SHIIP/SMP immediately.

“By reporting billing errors and suspected fraud, Iowa Medicare beneficiaries, their family and caregivers can play a big part in protecting themselves from healthcare scams and save the Medicare system for future generations,” said Gross. “More than $50 billion lost to Medicare fraud annually is a national epidemic. We all should be very concerned and properly educated on how to stop it and report it. If you are turning 65 this year and becoming Medicare eligible, please make an appointment with a SHIIP/SMP counselor to find the best plan for you and learn everything you should know to protect the government’s important investment in your health.”

Iowans are encouraged to visit shiip.iowa.gov/smp to learn about new Medicare insurance scams and discover tips and tools to prevent and report Medicare fraud. Iowans can also call 1-800-351-4664 to report Medicare fraud or to make an appointment with a SHIIP/SMP counselor.

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Lori Davis, Amperage PR Director

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