Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
Health Care Anti-Fraud, Waste, and Abuse 
Community Volunteer Program 
First Year Outcomes 
JUNE GIBBS BROWN 
Inspector General 
FEBRUARY 1999 
OEI-02-97-00522  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 Dunn, Deputy Regional Inspector General.  Principal OEI 
staff included: 
REGION  HEADQUARTERS 
Jodi Nudelman, Project Leader  Susan Burbach, Program Specialist

Judy Lin

Miriam Gareau

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 the first year performance of the Health Care Anti-Fraud, Waste, and Abuse 
Community Volunteer Demonstration Program. 
BACKGROUND 
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) in order to further curb losses to the Medicare program.  The Senate 
Committee believed that retired professionals, with appropriate training, could serve as 
educators and as resources to assist Medicare beneficiaries and others to detect and report 
fraud, waste, and abuse.  To fund this program, the Senate Report (104-368) directed that 
$2 million be transferred to the Administration on Aging (AoA) from the Health Care 
Financing Administrations research and demonstration budget.  In May of 1997, AoA 
awarded grants to 12 organizations. 
The Senate Report also directed AoA to consult with the Office of Inspector General 
(OIG) and the General Accounting Office to assess the performance of the program.  In 
response, the OIG developed performance measures with the assistance of the 12 projects. 
This report is based on performance data reported by the projects for the first year of the 
program.  These data are self-reported and were not independently verified. 
FINDINGS 
Recruiting and Training 
The 12 projects recruited and trained a substantial number of individuals as 
Medicare educators and resources, although not all were retired professionals.  In 
the first year, the projects collectively recruited and trained 3,682 trainers, at least 1,738 
(47 percent) of whom were retired professionals. 
Educating Seniors 
The projects educated a large number of seniors about Medicare fraud.  In total, the 
projects reported training nearly 41,800 Medicare beneficiaries and family members to 
detect and report suspected cases of health care fraud, waste, and abuse. 
1
 Community Awareness 
The projects conducted other types of anti-fraud activities, making many  in the 
community aware of Medicare fraud.  The 12 projects generated a total of 386 public 
service announcements that reached an estimated 44 million individuals in the first year of 
the program.  The projects also reported conducting 877 community education events that 
informed an estimated 263,000 seniors and members of the community. 
Identified Referrals 
The projects identified instances of potential fraud, waste, and abuse.  As a result of 
their outreach activities, the projects received a total of 657 allegations of fraud, waste, or 
abuse that were referred to Medicare contractors or investigative agencies.  Eighty-eight 
have been identified as potential overpayments.  Four projects estimated that as much as 
$1.16 million in Medicare funds may be recouped.  The remaining eight projects were not 
able to identify any potential Medicare savings, perhaps because of the recency of some of 
the referrals or the difficulty of tracking these outcomes. 
Range of Outcomes 
The projects produced a wide range of outcomes in the first year.  Several projects 
trained fewer than 40 seniors, whereas one project trained greater than 1,700 individuals. 
The number of allegations also varied, ranging from 1 to 200.  These outcomes did not 
appear to be associated with the type of organization.  Rather, grantees representing all 
three types of organizations including area agencies on aging, State units on aging, and 
private aging organizations, achieved results. 
CONCLUSION 
First year performance data reported by the 12 projects show that the projects recruited 
and trained volunteers, educated Medicare beneficiaries, and identified instances of 
potential fraud, waste, and abuse.  The data also indicate that the individual projects had 
very different experiences which suggests that they adopted different approaches to 
recruiting and training volunteers or that some had slower starts than others. 
Before a new round of grants is awarded, it is important to learn from projects 
experiences.  Such information will assist AoA in providing guidance to current and future 
projects and will improve performance and ensure quality outcomes.  To do this, we will 
conduct an inspection that will identify and describe key implementation issues including 
what problems projects face and what practices work best.  The report will also focus on 
curricula for training trainers, best practices for tracking trainers activities and fraud 
allegations, and efforts to document outcomes. 
Additionally, AoA needs to clarify guidance to projects about the extent to which they 
should focus their efforts on recruiting and training retired professionals and on investing 
time and resources in broader community education activities. 
2
 T A B L E  O F  C O N T E N T S  
PAGE

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

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

FINDINGS 
Recruiting and Training  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Educating Seniors  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Community Awareness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9

Identified Referrals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  10

Range of Outcomes  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Type of Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Project Spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  12

CONCLUSION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  13

APPENDICES

A. Selected Project Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

B. Performance Measures and Definitions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

C. First Year Outcomes for the Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

3
 I N T R O D U C T I O N  
PURPOSE 
To report on the first year performance of the Health Care Anti-Fraud, Waste, and Abuse 
Community Volunteer Demonstration Program. 
BACKGROUND 
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) in order to bring more resources to bear on the effort to curb losses 
to the Medicare program.  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 resources to assist 
Medicare beneficiaries and others to detect and report fraud, waste, and abuse.1  Because 
the language for this program was introduced by Senator Tom Harkin of Iowa, these 
grants are commonly referred to as Harkin Projects. 
To fund this program, the Senate Report (104-368) directed that $2 million be transferred 
to the Administration on Aging (AoA) from the Health Care Financing Administrations 
research and demonstration budget.  In May of 1997, AoA awarded funds to 12 
organizations including two area agencies on aging, six State units on aging, and four 
private aging organizations.  (See Appendix A for selected characteristics of the projects.) 
These grants were awarded to different types of organizations to examine whether various 
approaches were successful in recruiting and training volunteers to educate seniors about 
Medicare fraud.  This report assesses the performance of these 12 projects for the first 
year of the program. 
As of October 1998, the program was expanded.  Under Title IV of the Older Americans 
Act in the FY99 Omnibus Appropriations bill, funding for the program was increased to 
$7 million, making the demonstration program a national effort and significantly extending 
the scope of the program. 
1The Health Care Financing Administration (HCFA) defines fraud as an intentional 
deception or misrepresentation that could result in payment of an unauthorized Medicare 
benefit.  HCFA defines abuse as a provider practice that directly or indirectly results in 
unnecessary costs to Medicare or improper reimbursement. 
4  Performance Measures 
The Senate Report also directed AoA to consult with the Office of Inspector General 
(OIG) and the General Accounting Office to assist them in implementing the program and 
in developing outcome measures to assess the performance of the projects.  In response, 
the OIG developed performance measures with the assistance of the 12 projects.  As 
presented in the report Health Care Anti-Fraud Volunteer Project Performance Measures 
OEI-02-97-00520, OIG staff reviewed the approved grantee applications and created a 
logic model.  This model and proposed performance measures were shared with each of 
the projects and the measures were revised with their assistance.  These measures are 
listed in Appendix B and include: 
<  the number of  volunteers trained,

<<  the number of educational sessions led by the trainers,

<<  the number of Medicare beneficiaries educated, 

<<  the number of referrals, cases, and recoveries attributable to the project

In this earlier report, project directors also highlighted several problems they faced in 
implementing their program plans.  Specifically, they reported difficulty in limiting their 
recruitment to retired professionals, as intended, because non-professionals also presented 
a willingness to volunteer.  They also noted that they were recruiting individuals to be 
trainers within the existing network, as well as outside this network.  Discussions further 
revealed that projects were at very different stages of implementation. 
To provide ongoing information about the project, the OIG asked each of the projects to 
provide data on the agreed upon performance measures on the 12, 18, 24, and 30 month 
anniversary of the initial grant.  At the request of AoA, the OIG will prepare a report 
analyzing the data for each reporting period.  This inspection covers the first year of the 
program and is the first in a series of reports. 
Other Anti-Fraud Outreach Initiatives 
The AoA has received funding for another community-based initiative with a similar 
purpose, combating fraud, waste, and abuse in the Medicare and Medicaid programs. 
Under the Health Insurance Portability and Accountability Act (HIPAA), AoA awarded 
anti-fraud and abuse grants to 18 State agencies.  In addition to funding outreach training 
for aging network staff, these HIPAA grants support public awareness campaigns and 
the development of training manuals and Internet websites, among other activities. 
Another initiative sponsored by the Department of Health and Human Services (HHS) 
seeks to educate a broader audience of Medicare beneficiaries about health care fraud. 
The OIG, in partnership with AoA, the Health Care Financing Administration (HCFA), 
the Department of Justice, and the American Association of Retired Persons, is planning a 
nationwide Medicare fraud outreach campaign in February 1999.  This campaign will use 
mass media to encourage Medicare beneficiaries to review their Explanation of Medicare 
Benefits to identify possible instances of fraud or abuse and to report them to the OIG 
Hotline. 
5
 Complementing these efforts, HHS is also implementing the Incentive Program for Fraud 
and Abuse Information.  Beginning in January 1999, this program will reward Medicare 
beneficiaries and others who report fraud and abuse in the Medicare program if their 
information leads directly to the recovery of money for fraudulent activity not already 
under investigation.  Beneficiaries may gain a reward of up to $1,000, or 10 percent of the 
recovered funds. 
METHODOLOGY 
This report was conducted in two phases.  In the first phase, OIG staff pre-tested the 
performance measures that were developed with the 12 grantees.  To do this, staff asked 
each of the grantees to provide performance data for the time period covering July 1, 1997 
through either April or May of 1998.  The grantees were also asked to comment on the 
availability of these data and the workability of the definitions.  As a result of the pre-test, 
the performance measures were further revised. 
In the second phase, OIG staff asked the 12 grantees to provide data on the agreed upon 
performance measures for the first year of the program.  This time period covered July 1, 
1997 through June 30, 1998.  The findings in this report are based on these data. 
This inspection was conducted in accordance with the Quality Standards for 
Inspections issued by the Presidents Council on Integrity and Efficiency. 
Limitations 
It is important to note that the findings in this report are based on self-reported data that 
were not independently verified.  Furthermore, note that 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. 
Qualitative data and analyses on inputs, processes, outputs, and outcomes are needed to 
better understand these issues. 
6
 F I N D I N G S  
First year performance data reported by the 12 projects show that they recruited and 
trained volunteers, educated Medicare beneficiaries, and identified instances of potential 
fraud, waste, and abuse.  The data also indicate that the individual projects had very 
different experiences which suggests that they adopted different approaches to recruiting 
and training volunteers or that some had slower starts than others. 
Recruiting and Training 
The 12 projects recruited and trained a substantial number of individuals as 
Medicare educators and resources, although not all were retired professionals. 
In the first year, the demonstration projects reported collectively recruiting and training a 
total of 3,682 trainers, at least 1,738 (47 percent) of whom were retired professionals. 
(See Figure 1.) 
)))))))))))
7  Seven projects reported training more than 100 trainers each, whereas five programs 
trained between 27 and 85 trainers.  The New York State Unit on Aging trained more 
individuals than any other project, over 1,700 or nearly half of the total number trained by 
all projects.2  (See Appendix C for more detailed data by project.) 
Additionally, projects did not train only retired professionals.  Project directors explained 
that others also volunteered and that they believed that limiting training to retired 
professionals was inconsistent with the larger goals of the Older Americans Act.  Also, 
guidance from AoA on this objective was somewhat unclear. 
Educating Seniors 
The projects educated a large number of seniors about Medicare fraud. 
In total, the 12 projects reported educating nearly 41,800 Medicare beneficiaries and 
family members to detect and report suspected cases of health care fraud and abuse.  (See 
Figure 2.) 
The 12 projects typically conducted two types of training:  group and one-on-one. 
Overall, trainers led a total of 1,321 group sessions that reached about 40,365 seniors and 
others.  Most of the projects also conducted one-on-one training, perhaps taking 
advantage of the existing network of aging staff, to reach another 1,407 individuals.  The 
projects emphasized one-on-one training to different degrees.  Five projects informed 
fewer than 15 beneficiaries one-on-one, whereas four projects each met with more than 
150 seniors and family members in this manner. 
On average, however, trainers conducted relatively few sessions in the first year.  In 
almost every project, trainers conducted an average of less than one session each.  This 
finding suggests that most projects had not fully implemented their program and that 
trainers were just beginning to conduct sessions to educate seniors.  Across all projects, 
each training session included an average of about 30 seniors and others.  This points to 
the potential of the program to reach many more Medicare beneficiaries in the near future. 
2	 The New York State Unit on Aging also received a grant under the Health 
Insurance Portability and Accountability Act (HIPAA) that was used to support 
these same anti-fraud activities. 
)))))))))))
8  Figure 2

Number of Medicare Beneficiaries and Others Educated

In the First Year 
Total: 41,772 
Community Awareness 
The projects conducted other types of anti-fraud activities, making many in the 
community aware of Medicare fraud. 
Collectively, the 12 projects generated 386 public service announcements that reached an 
estimated 44 million individuals in the first year of the program.  The projects also 
conducted 877 community education events that informed an estimated 263,000 seniors 
and members of the community about Medicare fraud.  Most projects reported doing 
both types of activities, running a median of 19 public service announcements and 35 
community education events. 
)))))))))))
9  Identified Referrals 
The projects identified instances of potential fraud, waste, and abuse. 
As a result of their outreach activities, the projects received a total of 657 allegations of 
fraud, waste, or abuse.  These allegations were referred to Medicare contractors, Medicaid 
Fraud Control Units, State Attorney Generals, or the Office of Inspector General.  The 
number of allegations differed by project, ranging from less than 5 in two projects to 
greater than 140 in two other projects.  Of all allegations reported by the projects, 88 have 
been identified as potential overpayments which represent about 13 percent of all 
allegations. 
Based on these allegations, the projects estimated that as much as $1.16 million in 
Medicare funds may be recouped.  Four projects also reported referrals, amounting to 
another $39,000 in funds to other State and Federal programs.  (Note that the inspection 
team did not verify the reported savings.  We will seek to document these numbers in our 
next inspection on implementation issues.)  Eight projects were not able to identify any 
potential Medicare savings.  This may be partly due to the recency of some of the referrals 
they made to investigative agencies which often take six to eight months to resolve 
complaints.  In addition, it is unclear how projects track outcomes of complaints made 
directly to Medicare contractors and to the OIG Hotline.  Also, some projects seem to 
have been in earlier stages of developing a tracking system and may have had more 
difficulty reporting these outcomes. 
Range of Outcomes 
The projects produced a wide range of outcomes in the first year. 
Outcomes varied among the 12 projects.  Specifically, several projects trained fewer than 
40 seniors, whereas one project trained more than 1,700 individuals.  The projects also 
educated different numbers of Medicare beneficiaries, ranging from less than 600 in 
several projects to greater than 7,000 in four projects.  Productivity, measured in terms of 
the number of Medicare beneficiaries and others educated per trainer, also ranged widely. 
In one project, a trainer educated an average of 83 individuals.  Trainers in other projects, 
however, informed less than four beneficiaries per person.  Further, fraud and abuse 
results differed.  The number of allegations, for example, ranged from 1 to 200.  More 
specifically, five programs produced fewer than 20 allegations, whereas two projects 
reported greater than 100 allegations. 
Differences in outputs and outcomes may be partly due to projects adopting different 
approaches and being at varying stages of implementation.  For example, projects took 
different approaches to training trainers.  Projects that conducted several days of 
instruction often trained a relatively small number of individuals.  In contrast, projects that 
offered only a few hours of training typically trained a large number of seniors.  These 
)))))))))))
10  approaches may have had different effects on the quantity and also the quality of trainers. 
In addition, some projects had start up problems.  Administrative issues with host agencies 
or difficulty recruiting staff delayed training and resulted in some projects training fewer 
trainers. 
Variations in how the projects designed their complaint receipt and referral system may 
have also contributed to differences between projects outcomes.  Specifically, in the first 
year, some projects fielded complaints directly using their own toll-free numbers and staff. 
Other projects asked beneficiaries to call the OIG Hotline, the Medicare contractor, or the 
State Medicaid Fraud Control Unit directly.  These differences have implications for how 
well a project was able to track the number of allegations and the amount of money that 
was recouped due to their efforts. 
Type of Organization 
Outcomes did not appear to be associated with the type of organization, 
suggesting that different types of grantees can be successful. 
Different types of organizations were funded to support Congress desire to test various 
approaches to training volunteers and educating Medicare beneficiaries to combat health 
care fraud and abuse.  Specifically, the grantees that received funding included two area 
agencies on aging, six State units on aging, and four private aging organizations.  As 
noted, the grantees produced a wide range of results.  No one type of organization 
consistently produced better results on these performance measures than another. 
Moreover, no pattern by type of organization was discernible. 
From another perspective, grantees representing all three types of organizations achieved 
results.  Projects of all three types of organizations were successful in recruiting and 
training volunteers, each training over 100 individuals.  Similarly, grantees representing all 
three types of organizations educated a large number of Medicare beneficiaries and others, 
over 7,000 each. 
Several differences, however, were evident between organizations that served the entire 
State population and those that served a more limited geographical area.  Specifically, 
statewide organizations trained more volunteers but educated fewer beneficiaries, 
compared to regional organizations.  The six statewide grantees trained a median of 268 
trainers who educated a median of 842 individuals.  In contrast, the six regional grantees 
trained a median of 103 volunteers who educated over 2,320 Medicare beneficiaries and 
others.  Thus, regional organizations seemed to have been able to implement their plans 
more efficiently in the first year than programs that covered a larger area; they trained 
volunteers more quickly who were then able to train a larger number of seniors. 
)))))))))))
11  Project Spending 
The 12 demonstration projects spent a total of about $1 million in Federal grant 
money in the first year, about half of the total funds awarded. 
The projects were awarded about $2 million in Federal grant money which they often 
combined with funds from other sources.  The Federal funds were divided between the 
individual projects, with each grantee receiving between $100,000 and $188,000.  As 
shown in Appendix C, the projects spent very different amounts of these funds in the first 
year.  Most projects expended less than $100,000 each, which ranged from 16 percent to 
50 percent of their allotted funds.  Only four projects spent greater than $100,000, which 
in three of the projects, amounted to almost all of their funds.  Despite these differences, 
most projects spent at least 75 percent of their Federal grant money on recruiting, training, 
and supporting trainers. 
)))))))))))
12  C O N C L U S I O N  
First year performance data reported by the 12 projects show that they recruited and 
trained volunteers, educated Medicare beneficiaries, and identified instances of potential 
fraud, waste, and abuse.  The data also indicate that the individual projects had very 
different experiences.  These findings suggest that the projects adopted different 
approaches to recruiting and training volunteers or that some had slower starts than 
others. 
Before a new round of grants is awarded, it is important to learn from projects 
experiences and to explore which practices work best.  Such information will assist AoA 
in providing guidance to current and future projects and will improve performance and 
ensure quality outcomes.  To do this, we will conduct an inspection that will identify and 
describe key implementation issues.  These issues will include:  what problems projects 
face in implementing their plans; what solutions they develop to overcome these barriers; 
which types of projects are most successful; and which practices work best. The report 
will also focus on curricula for training trainers, best practices for tracking trainers 
activities and fraud allegations, and efforts to document outcomes. 
Additionally, AoA  needs to clarify guidance to projects about the extent to which they 
should focus their efforts on recruiting and training retired professionals and on investing 
time and resources in broader community education activities. 
13
 APPENDIX A 
Selected Project Characteristics

PROJECT  Total Proposed $  Total Proposed  Statewide  Type  of  Org. 
(x1000)  Federal $  coverage 
(x1000)  State  Private  Local 
Aging 2000  146  107  X  X

Providence, R.I. 
NH SUA  259  187  X  X 
Concord, N.H. 
NY SUA  250  188  X  X 
Albany, N.Y. 
CARIE  260  188  X

Philadelphia, PA 
MD SUA  240  180  X 
Baltimore, MD 
Suburban AAA  251  188  X

Oak Park, IL 
CWAG  173  127  X  X

Madison, WI 
MN SUA  239  178  X 
St. Paul, MN 
IA SUA  349  187  X 
Des Moines, IA 
Dist 3 AAA  158  117  X

Warrensburg , MO 
CHA  289  188  X  X

San Mateo, CA 
HI SUA  141  100  X  X 
Honolulu, HI 
TOTAL  2,755  1,935  6  6  4 2

14
 APPENDIX B 
Performance Measures

INPUTS: 
1 $ spent on recruiting retired professional 
2 $ spent on recruiting others 
3 $ spent on training retired professionals 
4 $ spent on training others 
5 $ spent to support retired professionals 
6 $ spent to support others 
7 $ spent on community education activities 
8 $ spent on tracking system 
OUTPUTS: 
9  # of retired professional trained 
10  # of other people trained 
11  # of public service announcements 
12  # of community education activities 
OUTCOMES: 
13  # of group sessions for beneficiaries led by retired professionals 
14  # of group session for beneficiaries led by others 
15  # of beneficiaries who attended sessions led by retired professionals 
16  # of beneficiaries who attended sessions led by others 
17  # of one-on-one encounters led by retired professionals 
18  # of one-on-one encounters led by others 
19  estimated # of people reached by media hits 
20  estimated # of people reached by community education 
21  # of referrals attributable to the project 
22  # of cases attributable to the project 
23  Medicare $ recouped attributable to the project 
24  other $ recouped attributable to the project 
15
 APPENDIX B 
Definitions

RETIRED PROFESSIONAL  These are retired individuals who were professionals (e.g.; 
teachers, lawyers, doctors, accountants, etc.), 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 group or one-on-one 
beneficiary education. 
PUBLIC SERVICE 
ANNOUNCEMENT  Any individual airing or publishing of media  (print 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 public service announcements. 
GROUP SESSIONS  Medicare fraud education sessions for beneficiaries and their 
families led by trainers. 
16
 APPENDIX B 
Definitions

ATTENDED
 The total number of individuals who attend the education 
sessions. 
ONE-ON-ONE ENCOUNTER
 Sessions led by trainers for an individual beneficiary and/or 
his or her family. 
REFERRALS
 Complaints deemed worthy of referring to an investigative 
agency. 
CASES
 Referrals successfully closed by an investigative agency. 
e.g.; conviction, judgement, plea. 
$ RECOUPED
 Funds returned to the Medicare Trust Fund. 
17
 APPENDIX C
First Year Outcomes for the Projects1
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  15,000 31,960 1,000 1,727 14,400 7,967 25,317 0 4,737 0 13,708 4,500 120,316
$ recruiting others 0 11,280 100 2,515 17,500 7,816 2,061 26,849 2,368 16,000 22,284 900 109,673
$ training retired prof 29,000 41,360 22,000 1,657 67,600 10,500 4,479 0 4,737 0 13,145 2,250 196,728
$ training others 14,000 13,160 8,000 2,086 12,800 6,821 1,217 3,922 0 18,400 27,455 11,250 119,111
$ support retired prof 11,000 35,720 1,000 2,805 10,200 8,963 6,170 0 1,597 0 6,273 2,250 85,978
$ support others 0 15,040 600 2,559 24,000 5,713 315 22,379 0 21,900 2,800 13,500 108,806
$ community education   24,000 20,680 1,000 16,495 12,400 7,171 44,028 0 2,368 0 25,925 9,000 163,067
$ tracking system 14,000 18,800 9,000 2,766 24,500 3,833 200 675 0 150 1,301 1,350 76,575
total $ spent 107,000 188,000 42,700 32,610 183,400 58,784 83,787 53,825 15,807 56,450 112,891 45,000 980,254
# retired prof trained 23 68 20 56 399 32 17 0 35 0 1,053 35 1,738
# of others trained 40 17 10 175 50 88 10 382 0 335 672 165 1,944
total # of people trained 63 85 30 231 449 120 27 382 35 335 1,725 200 3,682
# public service announce 19 19 10 54 21 17 109 80 0 0 55 2 386
# community education 7 35 60 81 181 16 34 0 6 60 393 4 877
# group sessions by prof 24 170 30 54 126 12 6 0 2 35 209 0 668
# group sessions by others 5 0 15 208 55 13 11 238 4 21 61 22 653
total # sessions 29 170 45 262 181 25 17 238 6 56 270 22 1,321
# of benes at ses. by prof 475 7,074 650 461 4,234 296 83 0 40 638 6,024 0 19,975
# of benes at ses. by others 55 0 350 2,869 5,203 541 390 8,522 355 440 1,080 585 20,390
total # of benes at sessions 530 7,074 1,000 3,330 9,437 837 473 8,522 395 1,078 7,104 585 40,365
# of 1-on-1 by retired prof 0 71 25 28 107 74 0 0 0 10 412 0 727
# of 1-on-1 by others 0 0 15 244 70 135 3 55 0 0 148 10 680
total of 1-on-1 0 71 40 272 177 209 3 55 0 10 560 10 1,407
total  of benes educated 530 7,145 1,040 3,602 9,614 1,046 476 8,577 395 1,088 7,664 595 41,772
est. # of people by media hits 1,175,000 1,770,797 500 10,000 1,500,000 50,000 194,000 38,812,650 0 75,000 462,400 15,300 44,065,647
est # of people by com educ. 540 4,185 1,000 90,500 23,437 50,000 5,000 0 390 10,000 77,292 600 262,944
# of referrals 11 16 30 51 142 200 4 60 1 10 59 73 657
# of cases 0 0 0 13 53 0 0 2 0 8 12 0 88
Medicare $ recouped  0 0 0 4,897 22,000 0 0 1,137,740 0 0 75 0 1,164,712
Other $ recouped 0 0 0 2,000 0 35,000 0 1,266 0 620 0 0 38,886
Total $ recouped 0 0 0 6,897 22,000 35,000 0 1,139,006 0 620 75 0 1,203,598 
1 Italicized zeros indicate grantees were unable to provide specific data. 
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