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Medicare News

Obama Administration Offering Seniors a Reward of Almost $10 Million for Exposing Medicare Fraud

Also funding expansion of Senior Medicare Patrol to spread the word on fraud, waste and abuse - elderly are on  'frontlines of this fight,' 'critical partners' in protecting taxpayer dollars

April 24, 2013 – The Obama Administration made it clear today that it is out to stop Medicare fraud. The proposal of a new rule today indicates they want to increase rewards paid to Medicare beneficiaries and other individuals whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million from the current limit of $1,000.

A new funding opportunity, also released this month, supports the expansion of Senior Medicare Patrol activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud, waste and abuse.

“President Obama has made the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration,” said Secretary of Health and Human Services Kathleen Sebelius today in announcing the new rule.

“Today’s announcement is a signal to Medicare beneficiaries and caregivers, who are on the frontlines of this fight, that they are critical partners in helping protect taxpayer dollars.”


Related Archive Stories


Five Ways the President's Budget Would Change Medicare; Reduce Spending $371 Billion in Decade

Wealthier beneficiaries to pay more for coverage and future retirees to pay higher copays for outpatient services such as doctor's visits and home health care

By Mary Agnes Carey, KHN Staff Writer

April 15, 2013


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Over the last three years we have recovered over $14.9 billion in fraud.  Some of this has resulted from fraud reporting by individuals –a proven tool for the government to detect fraud, waste and abuse in the Medicare program. 

Under the proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered up to $10 million. 

HHS currently offers a reward of 10 percent up to $1,000 under the current incentive reward program. The changes are modeled on an IRS program that has returned $2 billion in fraud since 2003.

The proposed rule would also strengthen certain provider enrollment provisions including allowing HHS to deny enrollment of providers who are  affiliated with an entity that has unpaid Medicare debt, deny or revoke billing privileges for individuals with felony convictions , and revoke providers and suppliers who are abusing their billing privileges.

The Senior Medicare Patrol (SMP) is a national, volunteer-based program that empowers Medicare beneficiaries to prevent and report Medicare fraud, waste, and abuse. Since 1997, more than 3.5 million beneficiaries have learned how to recognize and fight fraud and abuse, and more than 7,000 referrals have been made to CMS and the Office of the Inspector General for investigation.

To expand the SMP program’s capacity to reach more Medicare beneficiaries, the Administration for Community Living has issued a new Funding Opportunity.  Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program.

These proposed changes will support the administration’s comprehensive approach to program integrity, including the work being done with the Health Care Fraud Prevention and Enforcement Action Team, a joint effort by HHS and the Department of Justice to fight health care fraud that recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012.

   To see the proposed rule

   To learn more about Senior Medicare Patrols

   To see the funding opportunity announcement (pdf)


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