Minnesota Medical Care and Anti-Fraud Project

AOA.Gov, Mar 28, 2007

The Minnesota Medical Care and Anti-Fraud Demonstration Project is a collaborative effort between the Administration of Aging, Minnesota Board on Aging, and the Arrowhead and Southwest Area Agencies on Aging. The project goal is to train volunteer peer educators to empower other senior citizens by teaching them about Medicare benefits and to recognize and report questionable medical services and suspected cases of waste, fraud and abuse.

The program is a federal-state-community partnership to combat provider fraud and abuse in the Medicare and Medicaid programs.

The anti-fraud initiative began in 1995 as a 2 - year pilot called Operation Restore Trust (ORT) in five states: Florida, California, Texas, Illinois and New York. The Health Insurance Portability and Accountability Act of 1996 calls for creation of a nationwide health care fraud and abuse control program and establishes a Medicare Integrity Program funded from the Hospital Insurance Trust Fund. Medicare F.Y.I. results from this federal effort.

Legislation called for the effort to begin in 1997 - the point at which this program originated. Volunteers participate in the training element which precedes the implementation of community education and interaction.

Vigorous action is needed NOW to ensure public health dollars are spent for essential goods and services, and not for unethical business practices.

Statistic: The US General Accounting Office [GAO] estimates that $1 out of every $10 spent for Medicare and Medicaid is lost to fraud.

Medicare Fraud And Abuse Overview: Medicare Fraud Is a Federal Crime!

Fraud happens when someone knowingly and willfully lies in order to get paid. Fraud usually involves careful planning. It happens when a provider misrepresents on the claim form what was furnished.