KanCare | DCF | KDHE | Office of the Governor

Kansas Senior Medicare Patrol (SMP) empowers and assists Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. There are 54 SMP projects nationwide.

SMPs focus on three main areas:

1. Outreach and Education. SMPs give presentations to groups, exhibit at events, and work one-on-one with Medicare beneficiaries to prevent, detect, and report potential Medicare fraud. 
2. Volunteerism. The SMP program is a volunteer-based program. Protecting older persons’ health, finances, and medical identity while saving precious Medicare dollars is a cause that attracts civic-minded people to volunteer for the SMP program. 
3. Beneficiary Complaints. When Medicare beneficiaries, caregivers, and family members bring their complaints to the SMP, the SMP makes a determination about whether or not fraud, errors, or abuse is suspected. When fraud or abuse is suspected, they make referrals to the appropriate state and federal agencies for further investigation.

SMPs are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL). 

Medicare fraud assumes criminal intent. The Centers for Medicare and Medicaid Services (CMS) defines fraud as “the intentional deception or misrepresentation that the individual knows to be false or does not believe to be true,” and that is made “knowing that the deception could result in some unauthorized benefit to himself or herself or some other person.

Medicare and Medicaid Fraud	Identity Theft	Dumpster Diving	Protect Your Mail	Protect Your Personal Information	Protect Your Name	Telemarketing / Door-to-Door Sales

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Common Medicare Fraud Schemes

Ambulance COVID-19 Durable Medical Equipment (DME) Genetic Testing Home Health Care Hospice

Medical Identity Theft Medicare Marketing Violations and Enrollment Nursing Home Care Outpatient Mental Health Care Pharmacy and Prescription Drug Telehealth

The SMP Resource Center has produced a tip sheet warning about the most common Medicare fraud schemes. Please feel free to print this document with all the tip sheets: Fraud Schemes Fact Sheets

If you suspect Medicare fraud, errors, or abuse, address it immediately by taking these steps: 

• Rule out error: If you have questions about information on your or your loved one's Medicare Summary Notice (MSN) or Explanation of Benefits (EOB), call the provider or plan and ask for an explanation.
• Get help from your SMP: If you are not comfortable calling the provider or plan or if you are not satisfied with their response, your local SMP can help you:
  • Identify and report fraud schemes and deceptive health care practices, such as illegal marketing or billing for services that were never provided.    
  • Refer complaints of potential fraud and abuse to the appropriate entity, who can intervene.  For example:
    • HHS Office of Inspector General (OIG)
    • Centers for Medicare & Medicaid Services (CMS)
    • State attorneys general
    • Local law enforcement
    • State departments of insurance
    • State Medicaid Fraud Control Units (MFCU)
• Get help from other sources:
  • Contact local law enforcement
  • Call 1-800-Medicare
  • Report directly to the OIG Hotline: 1-800-HHS-TIPS (800-447-8477)

Suspected Fraud Reporting Resources

When reporting fraud, have the following information available:

• Your name as listed on your Medicare or Medicaid card
• Medicare number
• Name of the provider
• Date of service
• Description of the concern or problem 

Call Kansas SMP at 800-432-3535

The SMP program offers volunteers an opportunity to make an important difference in their communities. Volunteers take pride in working to ensure that the Medicare program will be protected for future generations.

What SMP Volunteers Do

SMP projects match a volunteer’s skills and interests to the needs of the program. As a result, SMP volunteers may serve Medicare beneficiaries, their families, and caregivers in many creative ways. However, there are six types of activities most commonly conducted by SMP volunteers nationwide:

1. Assist with administration: Help with work such as copying, filing, data entry, and placing outbound phone calls in support of SMP activity
2. Distribute information: Help with transporting and disseminating SMP information materials to sites and events; may include presenting prepared copy or performing scripted activities for small groups
3. Staff exhibits: Help by staffing information booths or exhibits at events such as health fairs; also may provide general information about SMP to the public and answer basic questions
4. Make group presentations: Help by giving presentations on SMP topics to small and large groups; may interact with the audience by answering questions and through discussion
5. Counsel: Help by having direct conversations with beneficiaries about their individual situations; may include review of personal information such as Medicare Summary Notices, billing statements, and other related financial and health documents
6. Manage interactions and referrals: Help beneficiaries who are reporting specific instances of health care fraud, errors, and abuse; may refer suspected fraud and abuse to the appropriate authorities

Interested? Call 800-432-3535 or download the volunteer brochure below.

This project was supported, in part, by grant number 90MP0087 from the U. S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, represent official Administration for Community Living policy.