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Coalition of Wisconsin Aging Groups - Wisconsin's SMP
Who We Are
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Wisconsin's SMP is a program of the Coalition of Wisconsin Aging Groups. Staffed by a project director, a volunteer coordinator and volunteers, Wisconsin's SMP is one of the oldest federally funded "fraud buster" programs in the country. The project is dedicated to stopping healthcare fraud, waste and abuse.
What We Do
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Wisconsin's SMP provides training and information to Medicare
and Medicaid beneficiaries and the public on issues such as:
What is Medicare/Medicaid and who qualities?
What benefits are available at what cost?
What is Medicare Part A, Part B, Part C and Part D?
What is healthcare fraud, waste and abuse? How does it affect benefits?
What can be done if there is over-billing on a Medicare statement?
How can others in your community be edcuated to understand and maximize their Medicare/Medicaid benefits?
Why is healthcare fraud, waste and abuse a concern?
Medicare/Medicaid error, fraud, waste and abuse result in a loss of over $12 billion each year. The Medicare program is important and needs to be protected so the benefit will be available for future generations.
National Medicare Facts
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41.7 million seniors and disabled Americans receive Medicare
900 million Medicare Summary Notices (MSN) are processed each year
There are more than 1.1 million providers $235 billion paid in claims each year
Wisconsin Statistics
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800,000 Wisconsin citizens receive Medicare
$4 billion paid in claims each year
Whose Money Is Wasted?
-------------------------------------------------------------------------------- Part A is funded by payroll taxes Part B is funded by premiums and general tax revenues Part D (Medicare Prescription Drug program begins January 1, 2006) is funded by premiums (including deductibles and co-pays) For more information please contact: For more information please call 800.488.2596, ext. 317or email econrad@cwag.org
Become an SMP Volunteer
We offer a number of volunteer opportunities giving you a chance to help stamp out waste, fraud and abuse in the Medicare and Medicaid programs.
Fraud Alert - The Newsletter of Wisconsin's SMP
Wisconsin's SMP publishes a free monthly newsletter which contains relevant information on healthcare and consumer protection issues, including fraud, waste and abuse in the Medicare program. It also highlights volunteer activities around the state of Wisconsin.
Learn More About Medicare Fraud and Abuse
Providers and suppliers have a legal obligation to conform to the requirements of the Medicare program. This section includes an explanation of what constitutes fraud and abuse in the Medicare and Medicaid programs and uses examples to illustrate each point.
Sanctions for Fraud and Abuse
Besides criminal penalties for engaging in fraud or abuse of federal health care programs, administrative sanctions can also result. They may include program exclusions or civil actions. Title XI of the Social Security Act provides several bases for individuals and entities from participation in Medicare, Medicaid and other federal health care programs. This section includes an explanation of what constitutes a program exclusion or civil action and includes examples of both.
Common Fraud Schemes by Durable Medical Equipment (DME) Providers
The durable medical equipment (DME) industry has consistently been complicit in fraudulent schemes. Examples include billing for equipment never delivered, billing for higher-cost equipment than actually delivered, and billing for unnecessary equipment or supplies. This section shows cases of fraud involving DME suppliers.
Common Schemes of Transportation Fraud
Common Medicare and Medicaid fraud schemes involving transportation and ambulance companies include submitting false claims. This section provides examples of transportation fraud perpetrated by an ambulance company, by a former president of an ambulance company and by several hospitals.
Civil Penalties for Patient Dumping
Section 1867 of the Social Security Act states that when someone goes to the emergency room for examination or treatment, a hospital having a Medicare provider agreement is required to conduct an appropriate medical screening examination to determine whether the individual has an emergency medical condition. This section outlines the exceptions rule to Section 1867 and includes examples of patient dumping involving two separate hospitals and a practicing licensed physician.
Medicare/Medicaid Fraud Referral Instructions and Form
This section provides step-by-step instructions and the form for
reporting an allegation of Medicare or Medicaid fraud, waste, error or
abuse. For more information, contact the Medicare Integrity Project at 1-800-488-2596 ext. 317 or e-mail.
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