Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Administration  on Agings Health Care 
Fraud and Abuse Programs 
18-Month Outcomes 
JUNE GIBBS BROWN 
Inspector General 
August 1999 
OEI-02-99-00110  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them.  This statutory mission is carried out through a 
nationwide program of audits, investigations, inspections, sanctions, and fraud alerts.  The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General.  It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public.  The 
inspection reports provide findings and recommendations on the efficiency, vulnerability, and 
effectiveness of departmental programs. 
OEI's New York regional office prepared this report under the direction of John I. Molnar, 
Regional Inspector General, and Renee C. Dunn Deputy Regional Inspector General.  Principal 
OEI staff included: 
REGION  HEADQUARTERS 
Jodi Nudelman, Project Leader  Susan Burbach, Program Specialist 
Judy Lin  Linda Hall, Program Specialist 
To obtain copies of this report, please call the New York Regional Office at (212) 264-2000. 
Reports are also available on the World Wide Web at our home page address: 
http://www.dhhs.gov/progorg/oei  E X E C U T I V E  S U M M A R Y  
PURPOSE 
To report on 18-month performance of the Administration on Agings (AoA) two health care 
fraud and abuse control programs. 
BACKGROUND 
The AoA asked the Office of Inspector General (OIG) to assess the performance and 
implementation of its two health care fraud and abuse control programs:  the Health Care Anti-
Fraud, Waste, and Abuse Community Volunteer Program and the Health Insurance Portability 
and Accountability Act (HIPAA)-funded Program.  AoA will use this information to inform 
Congress and others about the programs performance and to develop guidance for current and 
future projects. 
Both of these programs aim to educate beneficiaries about health care fraud, waste, and abuse, 
but operate somewhat differently.  The community volunteer program receives $2 million and 
provides grants to 12 organizations to recruit and train retired professionals to conduct group 
sessions to educate beneficiaries.  This program has recently been expanded to $7 million.  The 
second program receives $1.4 million in funding under the Health Insurance Portability and 
Accountability Act (HIPAA) of 1996.  The goal of this program is to train aging network staff 
and volunteers to educate Medicare beneficiaries about health care fraud, waste, and abuse as part 
of their ongoing activities. 
In response to AoAs request, the OIG developed two reports.  This report presents 18-month 
performance data for the two programs and a companion report entitled,  AoAs Health Care 
Fraud and Abuse Programs: Implementation Issues  OEI-02-99-00111, describes implementation 
issues and effective practices of the two programs.  The findings in these reports are based on 
self-reported data that were not independently verified. 
FINDINGS 
The AoAs two anti-fraud programs educated thousands of beneficiaries who identified 
some instances of health care fraud, waste, and abuse. 
In their first 18 months of operation, AoAs two anti-fraud programs trained a total of 13,700 
aging network staff, volunteers, and retired seniors to be Medicare educators and resources. 
These trainers educated at least 71,460 Medicare beneficiaries about how to identify and report 
1
 suspected instances of health care fraud and abuse. Additionally, the two programs reported 
conducting 570 media events and 2,880 community education activities. 
In total, the programs referred 871 allegations to Medicare contractors or other agencies for 
follow-up.  These referrals generated 133 complaints that resulted in some action.  The projects 
also reported that an estimated $1.24 million in Medicare funds and $102,000 in Medicaid and 
other funds may be recouped as a result of their efforts. 
The two programs produced different results. 
The community volunteer projects recruited and trained 3,700 individuals to educate beneficiaries. 
More than half were retired professionals.  These trainers educated about 58,700 beneficiaries and 
family members in group sessions, teaching them how to identify and report health care fraud and 
abuse.  They reached another 2,000 beneficiaries in one-on-one sessions.  In total, five community 
volunteer projects reported a potential $1.24 million in Medicare savings. 
The HIPAA-funded projects trained over 10,000 individuals who were primarily ombudsman staff 
and volunteers or health insurance counselors.  These trainers were able to reach at least 10,000 
beneficiaries.  The HIPAA-funded projects did not specifically report data on the number of 
beneficiaries reached in one-on-one sessions.  None of these projects could document any 
potential Medicare savings as of 18 months, partly because many of these projects did not track 
complaint outcomes. 
CONCLUSION 
Two outcome measures are particularly important for measuring the performance of these two 
programs: the number of  beneficiaries educated and the amount of money saved by the programs. 
Educating Beneficiaries:  Both programs educated an impressive number of beneficiaries.  The 
community volunteer program, however, appeared to reach a greater number of beneficiaries than 
the HIPAA-funded program. This difference was partly due to the different approaches that the 
two programs implemented.  Specifically, the community volunteer program generally followed a 
train-the-trainer approach in which the trainers conducted group sessions, whereas the HIPAA-
funded program trained existing network staff and volunteers who met with beneficiaries one-on-
one, as part of their ongoing responsibilities. 
Tracking Savings:  Direct evidence about savings was difficult to obtain.  While the programs 
were successful in educating beneficiaries, there was no direct evidence that they produced more 
savings than the amount of money that was invested in them.  There are a number of reasons for 
this lack of evidence.  First, beneficiaries are often encouraged to call their provider or Medicare 
contractor with problems and projects may not be aware of these activities.  Second, the projects 
2
 are relatively new and not all of them have developed tracking systems for the complaints that 
come to their attention.  Third, the investigative and prosecutorial processes are lengthy and 
therefore 18 months may not be enough time to achieve significant savings.  Lastly, there is likely 
to be a sentinel effect from this initiative that is reducing inappropriate billing. 
Additionally, we found that performance among the projects was very uneven.  While many 
projects were successful in educating beneficiaries and in identifying some savings, almost an 
equal number produced minimal results during the first 18 months of the program. 
Based on these findings, we encourage AoA to continue its work with the projects to identify and 
institutionalize effective practices.  Further, as AoA expands the community volunteer program, it 
needs to assist new grantees so that they do not  reinvent the wheel as they start-up their 
efforts.  We hope that this report and our companion report will help AoA achieve these 
objectives and help new grantees, as well as current projects, implement effective practices and 
improve future performance. 
COMMENTS 
We received comments from AoA.  They pointed out the difficulty in tracking specific dollar 
savings early in the program.  However, they are optimistic that the thousands of trained 
beneficiaries will have a significant impact on fraud, waste, and abuse in the Medicare program. 
The full text of AoAs comments can be found in Appendix D. 
3
 T A B L E  O F  C O N T E N T S  
PAGE

EXECUTIVE SUMMARY  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

FINDINGS

AoAs Anti-Fraud Programs  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Community Volunteer Projects  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

HIPAA-Funded Projects  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Performance Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  18

APPENDICES

A. List of Health Care Fraud and Abuse Projects  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

B. Performance Data Reported by Community Volunteer Projects . . . . . . . . . . . . . . . .  20

C. Performance Data Reported by HIPAA-Funded Projects . . . . . . . . . . . . . . . . . . . . . 25

D. AoAs Comments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

4
 I N T R O D U C T I O N  
PURPOSE 
To report on 18-month performance of the Administration on Agings (AoA) two health care 
fraud and abuse control programs. 
BACKGROUND 
The AoA asked the Office of Inspector General (OIG) to assess the performance and 
implementation of its two health care fraud and abuse control programs:  the Health Care Anti-
Fraud, Waste, and Abuse Community Volunteer Program and the Health Insurance Portability 
and Accountability Act (HIPAA)-funded Program.  AoA will use this information to inform 
Congress and others about the programs performance and to develop guidance for current and 
future projects. 
AoA asked OIG to evaluate the performance and the implementation of its anti-fraud initiatives 
for several reasons.  First, this information is a continuation of other work conducted by the OIG. 
At AoAs request, the OIG helped develop performance measures for the community volunteer 
program and agreed to collect these data on an ongoing basis.  Second, the results of the report 
that presented first year performance data entitled, Health Care Anti-Fraud, Waste, and Abuse 
Community Volunteer Program: First Year Outcomes OEI-02-97-00522, generated interest in 
implementation issues.  This report found that first year performance varied widely among the 12 
projects, suggesting that the projects implemented the program differently or that some had 
slower starts than others.  Third, Congress recently expanded the community volunteer program 
and AoA is currently selecting new grantees.  As a result of these factors, AoA believed that it 
was an important time to look at these issues. 
To meet these objectives, the OIG developed two reports.  The following report presents 18-
month performance data for the two programs.  A companion report entitled, AoAs Health Care 
Fraud and Abuse Programs: Implementation Issues OEI-02-99-00111, describes the 
implementation of these two programs including problems projects encountered and practices 
they developed to overcome these barriers. 
Operation Restore Trust 
In 1995, AoA became a partner in a OIG-led demonstration project to fight fraud, waste, and 
abuse in the Medicare and Medicaid programs called Operation Restore Trust (ORT).  This two-
year demonstration program focused on combating health care fraud, waste, and abuse in five 
States.  This initiative showed that Medicare beneficiaries and others could play an important role 
5
 in curbing losses to the Medicare and Medicaid programs by becoming better educated about how 
to identify and report suspected instances of fraud and abuse. The results of the demonstration 
program encouraged AoA to continue and to expand its efforts. 
Health Care Anti-Fraud, Waste, and Abuse Community Volunteer Program 
Congress authorized the Health Care Anti-Fraud, Waste, and Abuse Community Volunteer 
Demonstration Program in the Omnibus Consolidated Appropriation Act of 1997 (P.L. 104-208) 
to further reduce fraud and abuse in the Medicare and Medicaid programs.  At that time, the 
Senate Committee believed that thousands of retired accountants, health professionals, 
investigators, teachers, and others could serve as community volunteers in this effort.  More 
specifically, these retired professionals, with appropriate training, could serve as Medicare 
educators and as expert resources to assist Medicare beneficiaries and others to detect and report 
fraud, waste, and abuse.  Because the language for this program was introduced by Senator Tom 
Harkin of Iowa, these grants are commonly known as Harkin Projects.  For this inspection, they 
are referred to as the community volunteer projects. 
To fund this program, the Senate Report (104-368) directed that $2 million be transferred to AoA 
from the Health Care Financing Administrations research and demonstration budget.  In July of 
1997, AoA awarded grants to 12 organizations including two area agencies on aging, six State 
units on aging, and four private aging organizations. This report is based on these 12 projects. 
As of October 1998, the program was expanded.  Under Title IV of the Older Americans Act in 
the FY1999 Omnibus Appropriations Act, funding for the program was increased to $7 million, 
significantly extending the scope of the program.  AoA is currently reviewing applications and 
selecting grantees for this new round of funding.  These projects will be called the Senior 
Medicare Patrol Projects. 
HIPAA-Funded Program 
The AoA developed a second set of projects that are funded under the Health Insurance 
Portability and Accountability Act (HIPAA) of 1996. The goal of these projects is to combat 
health care fraud, waste, and abuse by training aging network staff and volunteers to educate 
Medicare beneficiaries.  In August 1997, AoA awarded grants to 15 State units on aging.  In 
March 1998, the program was expanded to include three additional States.  The program received 
a total of $3.8 million for the first three fiscal years.  In FY 99, $1.4 million in funding was 
provided.  About $900,000 of these funds was granted to State units on aging.  The remaining 
funds were used by AoA for training and technical assistance for the grantees, for facilitating the 
exchange of resources, for identifying best practices, for convening national and regional 
partnership conferences, and for developing and disseminating informational materials. 
6
 It is important to note that the two programs differ in several ways.  First, the HIPAA-funded 
projects primarily train aging network staff and volunteers who educate Medicare beneficiaries as 
part of their ongoing activities.  In contrast, the community volunteer projects recruit and train 
retired seniors who conduct group sessions to educate Medicare beneficiaries.  Second, the 
HIPAA-funded projects are run solely by State agencies, whereas the community volunteer 
projects  are operated by State, local, or non-profit agencies.  Third, the HIPAA-funded projects 
receive less funding than the community volunteer projects.  Specifically, AoA awarded $50,000 
annually to HIPAA-funded projects and between $100,000 and $188,000 per year to community 
volunteer projects. 
Performance Measures 
With the assistance of AoA and the 12 projects, OIG developed a set of performance measures 
for the community volunteer projects.  (See Health Care Anti-Fraud Volunteer Project 
Performance Measures OEI-02-97-00520.)  To provide ongoing information about the program, 
the OIG asked each of the projects to provide data on these agreed upon performance measures 
on the 12, 18, 24, and 30 month anniversary of the initial grant.  As mentioned earlier, first year 
outcomes are presented in the OIG report entitled, Health Care Anti-Fraud, Waste, and Abuse 
Community Volunteer Program: First Year Outcomes OEI-02-97-00522. 
Westat, Inc. a private research corporation under contract with AoA, developed performance 
measures for the HIPAA-funded projects.  Westat, Inc. collected preliminary outcome data for 
the first year and is currently conducting a longer-term evaluation of both fraud and abuse control 
programs.  This evaluation will provide a more in-depth analysis of the implementation and impact 
of the two programs. 
METHODOLOGY 
This inspection was conducted in several phases.  First, OIG staff collected performance data 
from the 12 community volunteer projects and 17 HIPAA-funded projects for the first 18 months 
of the programs.  Appendix A provides a list of all projects.  Note that the New York State Unit 
on Aging which receives funding from both programs is considered a community volunteer 
project for the purposes of this report.1  Also, this report includes first year performance data for 
the three HIPAA-funded projects that received funding in the second year. 
Community volunteer projects reported data for the measures developed by the OIG for the time 
period covering July 1, 1997 through December 31, 1998.  The HIPAA-funded projects reported 
data for the measures developed by Westat, Inc. for August 1,1997 through January 31, 1999. 
1Project staff explained that they use the community volunteer grant to fund several area 
agencies on aging to conduct anti-fraud activities and the HIPAA grant for administrative 
purposes. 
7  The OIG staff reviewed these data for consistency and compared them to 12-month data when 
appropriate.  Appendices B and C present the data reported by each project.  In addition, we 
asked grantees to provide documentation about any money that was identified due to their 
projects efforts. 
Second, we asked AoA for the projects  most recent semi-annual report that they submitted as 
part of AoAs reporting requirements.  Whenever possible, we compared these reports to their 
performance data to check for consistency. 
Third, we interviewed staff from each project.  We conducted interviews with staff members from 
selected projects on-site and interviewed the others by telephone.  We asked project staff about 
their experiences with implementing the program and about problems that they have had.  We also 
asked them to identify practices that have been effective, particularly in tracking outcomes.  The 
results of these data are reported in detail in our companion report entitled, AoAs Health Care 
Fraud and Abuse Programs: Implementation Issues  OEI-02-99-00111. 
As described, the two programs took different approaches to fighting health care fraud, waste, 
and abuse.  The measures that the programs were asked to report also differ in several ways.  For 
these reasons, we believe that a side-by-side comparison of the two programs is not appropriate. 
A separate analysis of each program is therefore presented. 
Limitations 
It is important to note that the findings in this report are based on self-reported data that were not 
independently verified.  Furthermore, outcome findings gauge the extent to which the program is 
achieving its intended goals; they do not provide information about the quality of these outcomes 
nor the implementation of the program. 
The following analysis does not solely focus on complaint outcomes for several reasons.  As 
described below, projects tracked these outcomes to different degrees.  The number of complaints 
that resulted in some action therefore may be an indication of a projects capacity to track, rather 
than its performance.  Additionally, complaints may take a long time to investigate and therefore it 
may be too early to evaluate a project based on these measures. 
This inspection was conducted in accordance with the Quality Standards for Inspections issued 
by the Presidents Council on Integrity and Efficiency. 
8
 F I N D I N G S  
The AoAs two anti-fraud programs educated thousands of beneficiaries 
who identified some instances of fraud and abuse. 
In their first 18 months of operation, AoAs two anti-fraud programs trained a total of 13,700 
aging network staff, volunteers, and retired seniors to be Medicare educators and resources. 
About 3,200 of these individuals, or 38 percent, went on to educate others or to conduct outreach 
activities about health care fraud, waste, and abuse. 
Trainers in the two program educated at least 71,460 Medicare beneficiaries and family members. 
Typically, they conducted group sessions or met with beneficiaries one-on-one, instructing them 
how to review their health care bills, statements, and other documents, and how to identify and 
report any suspected instances of fraud and abuse.  The two programs also reported conducting a 
total of 570 media events and 2,880 community education activities.  These activities were 
generally aimed at informing the larger public about these issues. 
In total, the programs referred 871 allegations to Medicare contractors or other agencies for 
follow-up.  These referrals generated 133 complaints that resulted in some action.  The projects 
also reported that an estimated $1.24 million in Medicare funds and $102,000 in Medicaid and 
other funds may be recouped as a result of their efforts.  Not all projects were able to identify 
potential Medicare savings. 
Several projects qualified the data they reported about complaints.  A few stressed that their 
numbers underestimated the impact of the program.  They explained that they sometimes 
encouraged beneficiaries to make complaints to their Medicare carrier or to the OIG Hotline 
directly.  They did not, however, have the capacity to track complaints made through these 
channels.  In addition, several projects noted that complaints often took a long time to investigate 
and therefore their outcomes may not be known at this time. 
9
 COMMUNITY VOLUNTEER PROJECTS 
The community volunteer projects generally implemented a train-the-trainer approach.  Projects 
typically recruited seniors at senior centers and in the community at large.  They then trained them 
to conduct presentations or group sessions to educate Medicare beneficiaries.  Additionally, most 
projects also trained aging network staff and volunteers who educated beneficiaries about fraud 
and abuse as part of their ongoing responsibilities.  These individuals typically included State and 
local long-term care ombudsmen, health insurance counselors, and others who worked directly 
with seniors. 
Training Trainers 
The 12 projects recruited and trained many retired seniors to be Medicare educators and 
trainers. 
Overall, the 12 community volunteer projects reported recruiting and training a total of 3,691 
individuals, at least half of whom were retired professionals.2  Projects employed different 
strategies to recruit individuals such as advertising in local newspapers and approaching members 
of existing senior organizations.  As shown in Figure 1, the number of trainers varied greatly by 
project. 
Figure 1 
Number of Trainers Trained in 18 Months 
Total: 3,691 
Note: Each grantee does not necessarily serve the entire State.  Source: OEI Survey, 1999 
2 Note that projects defined who they considered to be professional differently. 
Additionally, three projects did not track this type of information. 
10  Not all seniors who were trained, however, continued to stay involved in the projects.  Most 
projects maintained a smaller corps of active volunteers.  Taking into account the projects that 
tracked this information, about half of all individuals trained by the community volunteer projects 
ever conducted activities to educate beneficiaries.  This rate varied by project, indicating that 
some projects were less successful than others at getting trainers involved once they had 
completed training.  Six projects, for example, retained less than one-quarter of trainers, whereas 
the remaining five projects were able to involve at least two-thirds of all those trained. 
Educating Seniors 
Projects educated a large number of beneficiaries and others to identify and report health 
care fraud, waste, and abuse. 
Collectively, the 12 community volunteer projects reported educating about 60,734 beneficiaries, 
family members, and others in the first 18 months of the program.  As shown in Figure 2, the 
number of beneficiaries educated varied by project. 
The community volunteer projects typically conducted two types of training:  group and one-on-
one.  In total, trainers led 1,422 group sessions that reached nearly 58,691 beneficiaries and 
others.  All but two projects also conducted one-on-one sessions that reached another 2,043 
individuals.  Projects provided one-on-one assistance to varying degrees. 
Figure 2 
Number of Beneficiaries and Others Educated in 18 Months 
Total: 60,734 
Note: Each grantee does not necessarily serve the entire State.  Source: OEI Survey, 1999 
11
 There did not appear to be a strong relationship between the number of beneficiaries educated and 
the number of trainers in a project.  Some projects that trained relatively few trainers were able to 
reach many beneficiaries.  The project in Pennsylvania, for example, trained 60 individuals, 40 of 
whom ever conducted activities, and educated more than 6,000 beneficiaries.  Similarly, some 
projects that trained large numbers of trainers reached relatively few beneficiaries.  The project in 
New Hampshire, for example, trained 238 individuals, all of whom conducted some activities, but 
educated only 1,300 beneficiaries. 
Community Awareness 
Projects conducted various outreach activities, raising awareness about health care fraud 
and abuse. 
The 12 projects reported conducting a total of 420 media events that reached an estimated 68.5 
million people in the first 18 months of the program.  The projects also performed about 1,200 
community education activities that informed an estimated 168,850 individuals.  Overall, projects 
conducted a median of 20 media events and 51 community education activities.  Some projects 
placed more emphasis on these types of activities than others.  The project in Minnesota, for 
example, conducted 223 media events.  The projects in New York and Iowa each conducted 
about 300 community activities.  In contrast, a few projects held less than 15 of these types of 
activities. 
Identifying Referrals 
The projects identified suspected instances of fraud, waste and abuse, some of which may 
result  in recouped Medicare funds. 
Overall, the projects referred about 400 allegations to appropriate authorities.  The majority of 
these referrals came from two projects, Iowa and New York, which referred 171 and 52 
allegations, respectively.  Five other projects reported referring at least 20 complaints.  One 
project did not make any referrals. 
Projects reported that these referrals generated a total of 93 complaints that resulted in some 
action.  Five projects also reported that an estimated $1.24 million in Medicare funds may be 
recouped as a result of their efforts.  The other seven projects did not know or reported that none 
of the complaints they referred had resulted in Medicare funds being recouped.  In addition, six 
projects estimated that $102,000 in Medicaid and other funds may be recouped due to their 
projects efforts. 
12
 HIPAA-FUNDED PROJECTS 
The HIPAA-funded projects implemented the program differently than the community volunteer 
projects.  The HIPAA-funded projects primarily trained aging network staff and volunteers about 
fraud and abuse.  These individuals typically met with Medicare beneficiaries and others one-on-
one and integrated what they learned about fraud, waste, and abuse in their usual activities.  In 
general, these projects placed less emphasis on conducting group sessions to educate Medicare 
beneficiaries compared to the community volunteer projects. 
Training Trainers 
The HIPAA-funded projects trained large numbers of staff and volunteers, primarily in the 
aging network 
The 17 HIPAA-funded projects reported training a total of about 10,000 staff and volunteers to 
be Medicare resources and educators in the first 18 months of the program.  As shown Figure 3, 
the number of individuals trained varied greatly by project.  Unlike the community volunteer 
projects, it was not uncommon for these trainers to also educate additional staff and volunteers. 
Collectively, the projects reported conducting sessions to educate another 3,000 staff and 
volunteers about fraud and abuse. 
The variation in the number of trainers reflects the different approaches taken by the projects. 
The project in Colorado, for example, trained a small number of staff and volunteers who trained 
additional staff and volunteers.  In contrast, the project in Massachusetts, trained a large number 
of staff and volunteers who did not conduct any additional sessions to train others. 
In all but one project, the majority of people trained were staff and volunteers in the aging 
network.  These individuals typically included State and local long-term care ombudsmen, health 
insurance counselors, aging network service staff, and others who worked directly with older 
people.  Only five projects reported training staff and volunteers who were not in the aging 
network.  These individuals typically included senior advocates, retired seniors, and others. 
Although projects trained a large number of staff and volunteers, not all remained active.  Taking 
into account only the projects that tracked this information, an estimated 2,141 individuals, or 34 
percent of all those trained, were promoting awareness and the reporting of health care fraud and 
abuse at the end of the 18-month reporting period.  This rate greatly varied among the projects, 
indicating that some projects had greater difficulty retaining volunteers than others. 
13
 Figure 3 
Number of Trainers Trained in 18 Months 
Total: 10,001 
Note: Data for LA, NJ, and OR include only the first year of the program.  Source: OEI Survey, 1999 
Educating Seniors 
Several projects educated many Medicare beneficiaries and others. 
The HIPAA-funded projects reported educating a total of about 10,700 Medicare beneficiaries, 
family members, caregivers, and others.  As discussed, not all projects implemented the program 
in this way.  Also, the HIPAA-funded projects were not asked to specifically report the number of 
one-on-one sessions that they conducted.  Most likely, this information would have substantially 
increased the number of beneficiaries that were informed about fraud and abuse as a result of 
these projects. 
Most projects reported conducting some sessions to educate beneficiaries and others about health 
care fraud and abuse.  Six projects conducted at least 30 sessions each or informed more than 850 
beneficiaries each in this manner.  These projects appeared to be similar to the community 
volunteer projects.  For example, the project in Florida which followed the train-the-trainer 
model, reached the largest number of beneficiaries, over 4,100, or about 38 percent of the total 
number educated by all projects. 
14
 Figure 4 
Number of Beneficiaries and Others Educated in 18 Months 
Total: 10,727 
DK  DK 
Note: Data may not include beneficiaries educated in one-on-one sessions. 
Source: OEI Survey, 1999
Data for LA, NJ, and OR include only the first year of the program. 
DK indicates grantee was unable to provide specific information. 
Community Awareness 
The HIPAA-funded projects also conducted public awareness campaigns and other 
community outreach activities to reach a broader audience. 
HIPAA-funded projects reported conducting about 1,672 community education activities that 
informed more than 26,873 individuals about how to identify and report health care fraud and 
abuse.  The number of outreach activities conducted varied by project.  Specifically, seven 
projects conducted less than six presentations or other outreach activities each.  Two projects 
organized more than 320 of these types of activities each. 
The projects also developed a total of 152 public service announcements, press releases, or other 
media events.  In addition, all of the projects developed several types of other outreach materials 
that most distributed widely.  Collectively, the projects produced 155 brochures, posters, videos, 
public information documents, and training and other outreach materials.  Projects distributed 
about 192,200 copies of these materials to members in their respective communities. 
15
 Identifying Referrals 
Projects identified some instances of suspected fraud and abuse, although their outcomes 
are generally unknown. 
The HIPAA-funded projects reported receiving a total of 2,586 calls concerning health care fraud 
and abuse, during the 18-month reporting period.  They also reported referring 469 allegations to 
other agencies, forwarding almost half of them to Medicare contractors including carriers, 
intermediaries, or regional durable medical equipment carriers.  They referred another 20 percent 
of the allegations to the OIG Hotline.  The remaining complaints were sent to other health care 
programs such as insurance counseling agencies, State Medicaid Fraud Control Units, State 
Attorney Generals Offices, or other fraud and abuse agencies. 
Few HIPAA-funded projects tracked the outcomes of these complaints.  Seven projects reported 
that a total of 22 complaints were accepted for investigation by complaint-handling agencies. 
None of the projects documented that any complaints resulted in money being recouped or in a 
conviction or other punitive action, although it may be too early to know this information.  Two 
projects reported that 40 complaints resulted in some other type of action. 
It is important to note that the HIPAA-funded projects were not required to track complaint 
outcomes.  A few projects stressed that their role was to educate beneficiaries about how to 
detect and report fraud and abuse.  They believed the tracking and investigation was best left to 
investigative agencies such as the Medicare contractors, the OIG, and State Attorney Generals 
Offices.  In addition, a few projects noted that they had not received any feedback about 
complaints that they forwarded to the OIG Hotline. 
PERFORMANCE MEASURES 
Performance measures are viewed as too complex. 
Performance measures for the two grant programs were developed separately and take somewhat 
different approaches.  Project staff had mixed reactions to the performance measures. They most 
commonly stressed the need for simplified, well-defined measures that were not too burdensome 
to complete. 
The community volunteer projects were generally positive about the measures.  A few commented 
that it is somewhat difficult to gather the information, particularly the amount of money recouped 
as a result of their project.  They also noted that volunteers and AAA staff are often overworked 
and should not be overburdened with excessive paperwork. A few grantees specifically noted that 
it is very difficult, and perhaps unnecessary, to divide outcomes by retired professionals and 
others.  Several projects also suggested that if it is mandatory to collect these measures then they 
should be part of AoAs reporting requirements. 
16
 The HIPAA-funded projects had additional comments about their performance measures.  Several 
expressed that they were too detailed or cumbersome.  One project suggested eliminating some of 
the questions, noting that the easier the form, the more complete it will be.  A few reacted more 
strongly, stating that the measures did not fit what their project was doing.  As one grantee 
argued, there is a large gap between the reality of what we are doing and what is being 
reported.  Others stressed that they do not track outcomes nor do they have the capacity to 
divide their data into the required categories.  Several projects had some difficulty distinguishing 
between the categories and suggested clarifying key definitions. 
17
 C O N C L U S I O N  
Two outcome measures are particularly important for measuring the performance of these two 
programs: the number of  beneficiaries educated and the amount of money saved by the programs. 
Educating Beneficiaries:  Both programs educated an impressive number of beneficiaries.  The 
community volunteer program, however, appeared to reach a greater number of beneficiaries than 
the HIPAA-funded program.  This difference was partly due to the different approaches that the 
two programs implemented.  Specifically, the community volunteer program generally followed a 
train-the-trainer approach in which the trainers conducted group sessions, whereas the HIPAA-
funded program trained existing network staff and volunteers who met with beneficiaries one-on-
one, as part of their ongoing responsibilities. 
Tracking Savings:  Direct evidence about savings was difficult to obtain.  While the programs 
were successful in educating beneficiaries, there was no direct evidence that they produced more 
savings than the amount of money that was invested in them.  There are a number of reasons for 
this lack of evidence.  First, beneficiaries are often encouraged to call their provider or Medicare 
contractor with problems and projects may not be aware of these activities.  Second, the projects 
are relatively new and not all of them have developed tracking systems for the complaints that 
come to their attention.  Third, the investigative and prosecutorial processes are lengthy and 
therefore 18 months may not be enough time to achieve significant savings.  Lastly, there is likely 
to be a sentinel effect from this initiative that is reducing inappropriate billing. 
Additionally, we found that performance among the projects was very uneven.  While many 
projects were successful in educating beneficiaries and in identifying some savings, almost an 
equal number produced minimal results during the first 18 months of the program. 
Based on these findings, we encourage AoA to continue its work with the projects to identify and 
institutionalize effective practices.  Further, as AoA expands the community volunteer program, it 
needs to assist new grantees so that they do not  reinvent the wheel as they start-up their 
efforts.  We hope that this report and our companion report will help AoA achieve these 
objectives and help new grantees, as well as current projects, implement effective practices and 
improve future performance. 
COMMENTS 
We received comments from AoA.  They pointed out the difficulty in tracking specific dollar 
savings early in the program.  However, they are optimistic that the thousands of trained 
beneficiaries will have a significant impact on fraud, waste, and abuse in the Medicare program. 
The full text of AoAs comments can be found in Appendix D. 
18
 APPENDIX A 
The Health Care Fraud and Abuse Programs 
Community Volunteer Projects  HIPAA-Funded Projects 
State Units on Aging  State Units on Aging 
Hawaii
 Arizona 
Iowa
 California 
Maryland
 Colorado 
Minnesota
 Florida 
New Hampshire
 Georgia 
New York*
 Illinois 
Louisiana+ 
Area Agencies on Aging  Massachusetts 
District III AAA, Missouri  Missouri 
Suburban AAA, Illinois  New Jersey+ 
New York* 
Private Aging Organizations  Ohio 
Aging 2000, Rhode Island  Oregon+ 
California Health Insurance  Pennsylvania 
Counseling Advocacy Programs  Tennessee 
Coalition of Advocates for the Rights  Texas 
of the Infirm Elderly, Pennsylvania  Virginia 
Coalition of Wisconsin Aging Groups  Washington 
* Note: The New York State Unit on Aging receives both types of grants. 	 For the purposes of 
this report, it is considered a community volunteer project. 
+ Note: Incorporated at a later date and have only received funding for 
the second year. 
19
 APPENDIX B 
18-Month Outcomes Reported by the Community Volunteer Projects

State  RI  IL  PA  MD  CA  MO  MN  IA  HI  WI  NY  NH  TOTAL 
Projects  Aging 2000 Sub.AAA  CARIE  MD SUA  CHA  Dist 3 AAA  MN SUA  IA SUA  HI SUA  CWAG  NY SUA  NH SUA 
$ recruiting retired prof  20,000  35,445  20,200  0  7,447  19,692  30,818  0  12,693  0  12,870  12,663  171,828 
$ recruiting others  0  12,510  2,050  9,000  25,000  7,816  2,694  37,779  0  16,000  19,454  2,533  134,836 
$ training retired prof  40,000  45,870  30,000  0  57,344  22,225  8,245  0  38,078  0  10,329  37,990  290,081 
$ training others  34,362  14,595  10,000  2,380  15,000  6,821  11,369  5,941  0  19,100  23,968  6,332  149,868 
$ support retired prof  26,030  39,615  10,000  0  12,460  20,688  11,276  0  4,847  0  6,505  18,990  150,411 
$ support others  2,000  16,680  5,000  2,500  30,810  5,713  8,531  38,912  0  29,400  3,360  6,332  149,238 
$ community education  62,392  22,935  10,000  9,000  17,130  18,896  52,775  0  9,680  DK  54,581  37,990  295,379 
$ tracking system  19,000  20,850  15,000  3,750  22,140  3,833  2,828  675  0  1,650  1,307  3,799  94,832 
total $ spent  203,784  208,500  102,250  26,630  187,331  105,684  128,536  83,307  65,298  66,150  132,374  126,629  1,436,473 
# training sessions  4  7  15  1  24  9  15  15  6  14  DK  3  113 
# retired prof trained  23  85  50  0  483  31  28  0  42  0  941  215  1,898 
# of others trained  71  20  10  60  74  4  79  382  19  400  651  23  1,793 
total # of people trained  94  105  60  60  557  35  107  382  61  400  1,592  238  3,691 
# media events  7  28  20  27  39  24  223  DK  20  3  17  12  420 
# community ed. activities  14  46  100  187  0  48  53  334  11  79  297  40  1,209 
Note: DK indicates grantees were unable to provide specific data. 

20
 APPENDIX B 
18-Month Outcomes for the Community Volunteer Projects

State  RI  IL  PA  MD  CA  MO  MN  IA  HI  WI  NY  NH  TOTAL 
Projects  Aging 2000 Sub.AAA  CARIE  MD SUA  CHA  Dist 3 AAA  MN SUA  IA SUA  HI SUA  CWAG  NY SUA  NH SUA 
# trainers who did activities  23  105  40  10  505  35  23  30  5  40  DK  238  1,054 
# group sessions by prof  67  329  125  0  100  13  39  0  15  0  104  1  793 
# group sessions by others  20  21  25  23  104  40  43  156  25  67  70  35  629 
total # sessions  87  350  150  23  204  53  82  156  40  67  174  36  1,422 
# of benes at ses. by prof  1,372  14,857  5,000  0  7,417  346  804  0  292  0  4,006  1,200  35,294 
# of benes at ses. by others  209  340  1,000  368  7,715  1,439  1,460  4,259  1,071  2,027  3,409  100  23,397 
total # of benes at ses.  1,581  15,197  6,000  368  15,132  1,785  2,264  4,259  1,363  2,027  7,415  1,300  58,691 
# of 1-on-1 by retired prof  0  114  100  0  185  319  3  0  0  0  350  15  1,086 
# of 1-on-1 by others  0  0  30  272  61  227  15  75  0  35  237  5  957 
total of 1-on-1  0  114  130  272  246  546  18  75  0  35  587  20  2,043 
total of benes educated  1,581  15,311  6,130  640  15,378  2,331  2,282  4,334  1,363  2,062  8,002  1,320  60,734 
est. # of people by media hits  1,648,400  2,256,796 2,000,000  100,000  1,750,000  50,000  119,950  59,350,299  54,300  100,500  360,200  750,000  68,540,445 
est # of people by com ed.  3,440  4,583  3,000  8,000  0  50,000  7,353  12,726  446  11,179  66,118  2,000  168,845 
# complaints received  14  114  50  116  185  9  13  298  1  25  52  162  1,039 
# complaints referred  14  26  35  29  24  7  2  171  0  16  52  26  402 
# complaints resulted in action  DK  DK  10  29  4  0  0  12  0  10  23  5  93 
Medicare $ recouped  DK  DK  74,124  DK  22,000  0  0  1,138,534  0  1,972  2,999  0  1,239,628 
Other $ recouped  DK  DK  DK  DK  210  87,094  12,110  658  0  1,865  DK  100  102,036 
Total $ recouped  DK  DK  74,124  DK  22,210  87,094  12,110  1,139,192  0  3,836  2,999  100  1,341,665 
Note: DK indicates grantees were unable to provide specific data. 

21
 APPENDIX B 
Community Volunteer Projects:

Definitions

RETIRED PROFESSIONAL 	 These are retired individuals who were professionals (e.g., teachers, lawyers, 
doctors, or accountants), who are new volunteers to the aging network, and who 
are trained to help beneficiaries identify Medicare fraud. 
OTHERS	 These are any other individuals who are trained to help beneficiaries identify 
Medicare fraud. 
RECRUITING  Any effort to get individuals to take the training to become a trainer. 
TRAINING  The process of training the trainer. 
SUPPORT	 Any activity to help the trainers, such as transportation, renting space, printing 
material, and telecommunications. 
COMMUNITY EDUCATION	 Any training, outreach, or education activity not directed at the trainers nor 
specifically in support of the trainers.  It is geared to a broad audience. 
TRACKING SYSTEM  The process of receiving, referring, and monitoring complaints. 
TRAINED  Completed training to conduct beneficiary education. 
22
 APPENDIX B 
Definitions (continued)

MEDIA EVENTS	 Any individual airing or publishing of media  (e.g., print, radio, television, or 
electronic) to educate beneficiaries and their families about Medicare fraud.  (If it 
is geared to trainers it is recruiting.) 
COMMUNITY EDUCATION 
ACTIVITIES	 Any beneficiary education activity not given by trainers or counted as media 
events. 
BENEFICIARIES	 Includes beneficiaries, family members, caregivers, and others who attended 
sessions. 
GROUP SESSIONS	 Medicare fraud education sessions for beneficiaries, family members, caregivers, 
and others led by trainers. 
ONE-ON-ONE ENCOUNTER  Sessions led by trainers for an individual beneficiary and/or his or her family. 
COMPLAINTS	 Allegations of health care fraud and abuse reported by any individual as a result of 
the projects efforts. 
Definitions (continued) 
23
 APPENDIX B 
COMPLAINTS REFERRED 
FOR ACTION 	 Complaints deemed worthy of referring to a Medicare contractor or an 
investigative agency. 
COMPLAINTS THAT 
RESULTED IN SOME ACTION	 Referrals successfully closed by a Medicare contractor or an investigative agency 
(e.g., conviction, judgement, plea, or overpayment). 
MEDICARE $ RECOUPED  Funds returned to the Medicare Trust Fund. 
24
 APPENDIX C 
18-Month Outcomes Reported by the HIPAA-Funded Projects 

Activity  AZ  CA  CO  FL  GA  IL  LA  MA  MO  NJ  NY  OH  OR  PA  TN  TX  VA  WA  TOTAL 
I. Training, Education, and 
A. Materials development 
1. # of brochures, posters, media  3  4  4  1  2  2  2  2  1  0  33  9  2  3  1  6  5  3  50 
products, or 
other public information documents 
2. # of videos  2  0  0  1  0  0  0  0  0  0  5  1  1  0  0  DK  3  2  10 
3. # of training curricula, manuals,  2  3  2  4  2  3  1  5  2  25  35  DK  2  3  0  2  2  1  59 
handouts, 
or related instructional material 
4. # of other training, education, and  2  12  4  2  1  DK  3  0  0  0  5  5  2  DK  2  DK  2  1  36 
outreach 
materials 
Total  9  19  10  8  5  5  6  7  3  25  78  15  7  6  3  8  12  7  155 
B. Training and public information 
1. # of training sessions for network on  56  8  2  9  11  10  3  20  15  0  275  3  7  5  3  15  1  35  203 
aging 
agency staff, volunteers, and others 
2. # of network on aging staff and  875  350  2  130  600  345  46  2,200  736  0  1,397  188  660  217  95  654  80  1,130  8,308 
volunteers 
trained 
3. # of other staff and volunteers trained  88  1,114  0  31  0  0  0  0  0  0  100  0  DK  DK  0  460  0  DK  1,693 
4. # of forums and other public  81  701  25  70  2  2  2  5  0  12  137  37  3  5  32  24  37  86  1,124 
information 
presentations conducted (not in 1-3) 
Note: The total does not include New York.

25
 APPENDIX C 
5. # of persons attending these forums  2,081  2,000  DK  5,257  65  12  100  300  0  1,500  10,12  4,200  160  228  1,42  1,00  5,168  3,373  26,873 
and  5  2  7 
other public information 
presentations 
6. # of media events conducted  9  0  2  76  7  2  1  0  0  0  69  0  3  6  3  10  0  33  152 
7. # of public information items  45,15  14,00  1,75  15,58  800  1  1  500  2,00  0  DK  19,11  10,00  15,00  5,42  DK  12,88  50,00  192,21 
distributed  6  0  0  2  0  3  0  0  8  8  0  9 
(# of copies) 
8. # of other training, education, and  86  0  300  79  26  1  2  0  2  0  224  0  0  DK  0  26  50  1  548 
outreach activities 
Note: The total does not include New York. 
26  APPENDIX C 
Activity  AZ  CA  CO  FL  GA  IL  LA  MA  MO  NJ  NY  OH  OR  PA  TN  TX  VA  WA  TOTAL 
C. Activities of ORT trainees 
1. # of ORT trainees currently  96  1,112  DK  60  4  0  16  400  89  0  6,932  165  DK  DK  63  56  80  DK  2,141 
promoting 
awareness and reporting of health 
care 
fraud and abuse 
2. # of education and training sessions  58  7  15  0  0  2  6  0  0  0  240  0  9  5  3  3  0  DK  108 
by ORT trainees for staff and 
volunteers 
3. # of staff and volunteers attending  128  1,400  450  0  0  43  58  0  0  0  5,670  0  DK  560  285  68  0  DK  2,992 
these 
sessions 
4. # of sessions by trainees for  75  DK  30  52  3  45  1  0  1  0  758  0  DK  40  0  4  0  DK  251 
beneficiaries, 
family members, care givers, and 
others 
5. # of beneficiaries, family members,  1,801  1,000  856  4,120  97  1,071  22  0  20  0  9,184  0  DK  1,585  0  155  0  DK  10,727 
care 
givers, and others attending these 
sessions 
II. Health Care Fraud and Abuse 
Complaint Receipt and Referral 
A. Types of calls received 
1. # of calls concerning billing for services  6  DK  DK  DK  2  DK  0  DK  0  0  31  DK  DK  DK  0  DK  7  10  25 
not received 
2. # concerning double billing  3  DK  DK  DK  DK  DK  0  DK  0  0  48  DK  1  DK  0  DK  11  DK  15 
3. # concerning suppliers compiling CMN  0  DK  DK  DK  DK  DK  0  DK  0  0  0  DK  DK  DK  0  DK  0  DK  0 
for 
physician 
4. # concerning services not needed  2  DK  DK  DK  2  2  0  DK  0  0  131  DK  1  DK  0  DK  4  DK  11 
Note: The total does not include New York. 
27  APPENDIX C 
5. # concerning poor quality of care or  7  DK  DK  DK  DK  3  0  DK  0  DK  111  DK  DK  DK  0  DK  8  1  19 
limitations in needed care 
6. # concerning other health care fraud and  6  DK  DK  DK  3  1  0  DK  0  0  0  3  1  DK  0  DK  5  6  25 
abuse 
7. # concerning other health-related matters  3,653  DK  DK  DK  DK  2  0  DK  0  DK  160  3  DK  8  0  DK  10  26  3,702 
8. # concerning non-health issues  0  DK  DK  DK  DK  DK  0  0  0  DK  20  22  DK  DK  0  DK  8  DK  30 
Total  3,671  DK  DK  43  7  8  0  2,302  0  0  501  28  3  8  0  152  53  43  6,318 
Note: The total does not include New York. 
28  APPENDIX C 
Activity  AZ  CA  CO  FL  GA  IL  LA  MA  MO  NJ  NY  OH  OR  PA  TN  TX  VA  WA  TOTAL 
B. Complaints referred for action 
1. # referred to the HHS TIPS Hotline  26  6  DK  19  4  DK  6  DK  0  0  0  DK  DK  DK  0  29  DK  1  91 
2. # referred to the Medicare Carrier  3  123  DK  21  DK  5  0  DK  0  5  52  2  2  4  0  DK  15  3  183 
3. # referred to the Fiscal Intermediary  2  DK  DK  14  DK  DK  0  DK  0  0  0  DK  DK  DK  0  DK  12  DK  28 
4. # referred to the Regional DME Carrier  1  DK  DK  0  DK  DK  0  DK  0  3  DK  1  1  DK  0  DK  7  DK  13 
5. # referred to the State Medicaid Fraud  0  51  DK  5  DK  DK  0  DK  0  0  DK  1  DK  DK  0  DK  11  DK  68 
Control Unit/ Attorney Generals office 
6. # referred to other fraud and abuse  2  DK  DK  2  3  1  0  DK  0  0  DK  DK  DK  DK  0  DK  7  DK  15 
agencies 
7. # referred to other health care agencies  0  26  DK  11  DK  2  0  DK  0  DK  DK  24  DK  DK  0  DK  8  DK  71 
8. # referred to the Eldercare Locator  0  DK  DK  0  DK  DK  0  DK  0  0  0  DK  DK  DK  0  DK  0  DK  0 
Total  34  206  DK  72  7  8  6  DK  0  8  52  28  3  4  0  29  60  4  469 
C. Complaint outcomes 
1. # of referrals accepted for investigation  8  DK  DK  1  7  1  DK  DK  0  0  11  1  DK  DK  0  1  DK  3  22 
by 
complaint-handling agencies 
2. # of convictions or other punitive actions  DK  DK  DK  DK  DK  DK  DK  DK  0  0  0  DK  DK  DK  0  0  DK  DK  0 
3. Dollar amounts recouped (including fines  DK  DK  DK  DK  DK  DK  DK  DK  0  0  3,000  DK  DK  DK  0  0  DK  DK  0 
and restitutions) 
4. # of other actions  DK  DK  DK  DK  DK  DK  DK  DK  0  0  22  DK  DK  DK  0  39  DK  1  40 
Note: The total does not include New York. 
29  APPENDIX C 
Activity  AZ  CA  CO  FL  GA  IL  LA  MA  MO  NJ  NY  OH  OR  PA  TN  TX  VA  WA  TOTAL 
III. Building Partnerships 
A. Contacts with agencies and 
organizations concerning the design and 
operation of ORT 
1. # of contacts with the Medicare Carrier  84  5  14  14  20  1  2  12  5  1  81  4  0  12  10  2  33  DK  219 
2. # with the Financial Intermediary  27  DK  0  4  25  1  0  5  5  1  12  4  0  4  DK  2  21  0  99 
3. # with the Regional DME Carrier  18  DK  0  2  2  1  0  9  1  1  67  5  0  4  10  2  10  4  69 
4. # with the State Medicaid Fraud Control  21  4  1  15  8  5  2  5  3  1  78  1  10  4  2  2  21  30  135 
Unit/Attorney Generals office 
5. # with the State insurance counseling  DK  DK  0  58  10  7  2  DK  17  DK  2  20  10  DK  2  DK  29  DK  155 
6. # with the LTC Ombudsman program  DK  DK  2  17  DK  2  1  10  DK  DK  0  17  10  DK  5  DK  79  20  163 
7. # with other agencies/organizations  34  33  5  25  12  6  2  13  3  DK  93  6  10  12  30  DK  74  150  415 
Total  184  42  22  135  77  23  9  54  34  4  333  57  40  36  59  8  267  204  1,255 
B. Results of partnership-building 
activities 
1. # of training materials these agencies and  6  8  2  1  5  1  2  0  0  0  71  1  5  3  2  2  3  4  45 
organizations helped develop 
2. # of training sessions in which they  21  4  20  4  2  2  2  0  14  0  55  1  DK  5  5  1  1  35  117 
participated as trainers 
3. # of ORT task force or other meetings in  39  8  13  30  10  2  0  0  3  0  30  1  10  4  3  3  3  20  149 
which they participated 
4. # of written procedures developed with  10  4  5  0  1  1  0  1  0  0  25  3  0  1  1  1  0  11  39 
them to coordinate ORT activities 
Total  76  24  40  35  18  6  4  1  17  0  181  6  15  13  11  7  7  70  350 
Note: The total does not include New York. 
30  APPENDIX C 
Activity  AZ  CA  CO  FL  GA  IL  LA  MA  MO  NJ  NY  OH  OR  PA  TN  TX  VA  WA  TOTAL 
IV. Staffing and Management 
A. Uses of ORT funds 
1.. # of SUA staff supported in whole or in  6  0  1  2  1  0  0  0.5  0  0  0.75  2  0  0  1  0  0  0.17  14 
part with ORT funds 
2. # of AAA staff supported in whole or in  0  0  0  5  0  0  DK  0  0  0  3  DK  0  0  0  0  0  0  5 
part with ORT funds 
3. # of other agency/organization staff  2  3  2  0  0  1  DK  0  1  0  1  DK  1  1  2  0  3  0  16 
supported in whole or in part with ORT 
funds 
Total  8  3  3  7  1  1  0  1  1  0  4  2  1  1  3  0  3  0  35 
B. Leveraging of ORT resources 
1. # of network on aging staff supporting the  24  99  1  17  30  13  1  19  1  5  27  12  0  30  0  54  0  34  340 
ORT program who are paid for with 
other funds 
2. # of volunteers supporting the ORT  88  1,400  3  65  0  DK  46  400  0  400  1,500  DK  42  58  0 1,123  0  395  4,020 
program 
Total  112  1,499  4  82  30  13  47  419  1  405  1,527  12  42  88  0 1,177  0  429  4,360 
Note: The total does not include New York. 
31  APPENDIX C 
Operation Restore Trust Program Performance Report

Instructions and Definitions

Training and public information activities: Section I A and B of the report cover the initial materials development and train-the-
trainer sessions conducted by or on behalf of the ORT grantee.  Trainees consist of the network on aging and other staff and 
volunteers, including personnel from State and Area Agencies on Aging and service providers, and staff and volunteers from the 
Long Term Care Ombudsman and insurance counseling programs, among others. These activities also include other outreach and 
informational efforts, such as presentations to professional groups and public service announcements (PSAs) to inform the public 
about ORT and how to identify and report cases of health care fraud and abuse. A major purpose of the ORT training activities 
described in Section I B is to create a cadre of knowledgeable individuals who, in turn, educate beneficiaries and others who work 
with them to identify and refer potential cases of health care fraud and abuse to appropriate federal or state agencies. 
Activities of ORT trainees: Section I C covers the activities of these trainees after they return to their respective agencies and 
organizations. In many respects, this subsequent activity is the most important contributor to ORT success by promoting 
beneficiary awareness and reporting of fraud and abuse in the Medicare and Medicaid programs.  Reporting this information, 
however, requires the grantee to establish and maintain ongoing communication with trainees on ORT activities. 
Complaint receipt and referral activity: While the activities in this section are voluntary, AoA is encouraging all HIPAA grantees to 
build on or develop a state-level capacity to receive and screen calls about potential cases of health care fraud and abuse from 
Medicare and Medicaid beneficiaries, their family members or care givers, and others. Receiving these calls at the state level will 
allow screening for, and directly addressing, simple billing questions or other non-fraud and abuse cases that the state insurance 
counseling programs routinely handle. 
This also permits referral of the remaining calls to the most appropriate fraud and abuse agency, including the new HHS TIPS 
Hotline number for use by the ORT grantees.  Section II covers the receipt of these calls, the referral of these calls to the particular 
fraud and abuse agency, and the results or outcomes of these referrals, including the specific action these agencies took. Given the 
initial stages of ORT program implementation and the length of time it takes to resolve a complaint, call volume and resolution 
figures may not be high. 
32
 APPENDIX C 
Definitions (Continued)

Building partnerships: The ORT legislation calls for developing partnerships with other state and local agencies and organizations 
responsible for combating health care fraud and abuse.  The purpose of these partnerships is to provide for a logical link between 
ORT grantee activities and the work of other entities, including those that receive and investigate complaints. Please identify the 
agencies and organizations you have contacted and the results of your partnership-building activity during the reporting period. 
Staffing and management: ORT grantees vary in how they allocate their funds among the State Unit, Area Agencies, and others 
responsible for program implementation and operation.  In addition, many grantees are using the ORT award as seed money to 
stimulate the use of other resources to promote identification and reporting of health care fraud and abuse.  Identifying the number 
of staff and volunteers engaged in ORT activity, beyond the limits of the grant, helps demonstrate the extent to which ORT funds 
have leveraged other resources. 
33
 APPENDIX D 
s

t
n
e
m
m
o
C
34
 35
 36