DEPARTMENT OF HEALTH AND HrnvlAN SERVICES 

OFFICE OF INSPECTOR GENERAL 

WASHINGTON, DC 20201 

JUN I 3 2016 

TO: 	 John Wren 

Deputy Administrator for the Center for Integrated Programs 

Administration for Community Living 

FROM: 

SUBJECT: 	 Memorandum Report: Performance Data/or the Senior Medicare Patrol 

Projects: June 2016 Performance Report, OEI-02-16-00190 

This memorandum report presents perfmmance data for the Senior Medicare Patrol (SMP) 

projects for 2015. The Office oflnspector General (OIG) has collected these data since 

1997. In 2010, the Administration on Aging (AoA), which is now part of the 

Administration for Community Living (ACL), requested that OIG continue to collect and 

report performance data for the projects to support its efforts to evaluate and improve their 

performance. In 2015, ACL implemented a number of major changes. It substantially 

changed a number.ofthe performance measures and implemented a new data system midyear. As a result, ACL requested that for 2015, OIG focus its report on the perfmmance 

measures that did not change, which relate to recoveries, savings, and cost avoidance. OIG 

agreed to conduct the report in accordance with that request. 

SUMMARY 

ACL provides grants to the SMP projects to recruit and train retired professionals and other 

senior citizens to prevent, recognize, and report health care fraud, errors, and abuse. These SMP 

volunteers then participate in outreach events to help educate other Medicare and Medicaid 

beneficiaries to do the same. In 2015, the 54 projects had the following results: 

• 	 $2.5 million in expected Medicare recoveries that were attributable to the projects, a 

282-percent increase from 2014. 

• 	 No expected Medicaid recoveries. 

• 	 $35,059 in total savings to beneficiaries and others, a 56-percent decrease from 2014. 

• 	 $21,533 in cost avoidance on behalf of Medicare, Medicaid, beneficiaries, and others, 

an 89-percent decrease from 2014. 

We continue to emphasize that the projects may not be receiving full credit for recoveries, 

savings, and cost avoidance attributable to their work. It is not always possible to track referrals 

to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, 
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Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190)

waste, and abuse from the projects. In addition, the projects are unable to track the potentially 

substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of 

their bills reduce fraud and errors.

BACKGROUND

There is one SMP project in each of the 50 States, the District of Columbia, Puerto Rico, Guam, 

and the U.S. Virgin Islands. In 2015, funding for the projects totaled $17.6 million—

$8.9 million from ACL’s Older Americans Act funding, and $8.7 million in Health Care Fraud 

and Abuse Control Program (HCFAC) funding. Of the $8.7 million in HCFAC funding, $3.4

million supported infrastructure, technical assistance, and other SMP project activities, and $5.3

million was designated for expanding the projects’ capacity to detect and prevent fraud. In 2014, 

funding for the projects was $15.5 million.

Performance Measures

This report focuses solely on the performance measures related to Medicare and Medicaid 

recoveries, savings, and cost avoidance. ACL made no changes to these measures in 2015. 

Since the program’s inception, ACL has modified these measures in the following ways. In 

2007, the projects were required to begin measuring cost avoidance—the health care 

expenditures for which Medicare, Medicaid, a beneficiary, or another entity (e.g., a secondary

health insurer or a pharmacy) was relieved of responsibility for payment as a result of the 

projects. In 2012, ACL expanded the performance measures for both Medicare and Medicaid 

recoveries to account for expected recoveries as well as actual recoveries. This is consistent with 

the way OIG reports its recoveries.1 

ACL changed the other performance measures substantially beginning in September 2015. 

ACL’s goal was to align performance objectives more closely with the SMP program’s 

outcomes. To do that, ACL reduced the number of performance measures to 10, from 21

previously. ACL kept the five measures pertaining to recoveries, savings, and cost avoidance 

and created five additional measures that combined or redefined the prior measures pertaining to

volunteer and outreach activities. In addition, ACL no longer requires the projects to report on 

the number of media airings and their tracking of complex issues. 

Tracking Systems

Beginning in October 2015, ACL implemented a new reporting system called SMP Information 

and Reporting System (SIRS). The SMP projects are required to use this system to track and 

report activities and complaints and to refer cases to an investigative agency when necessary.

______________________________________________________________________________

1 As required by the Inspector General Act of 1978 (P.L. No. 95-452), as amended, OIG reports semiannually to the 

Secretary of Health and Human Services and to Congress on the activities of the office. In the semiannual report, 

OIG reports expected recoveries. See the most recent semiannual report at https://oig.hhs.gov/reports-andpublications/semiannual/index.asp.
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Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190)

Prior to implementing this system, ACL used a Web-based system named the Seniors Medicare 

Assistance and Reporting Tool for Fraud and Complaint Tracking System (SMART FACTS). 

METHODOLOGY

We based our review on data reported by 54 SMP projects for 2015.

2

 We focused this report on 

the performance measures related to recoveries, savings, and cost avoidance. At ACL’s request, 

we did not include the other performance measures, because ACL had changed them and

implemented a new reporting system midyear. 

To conduct this review, we requested and reviewed the projects’ documentation for expected 

recoveries of funds for the Medicare and Medicaid programs. We also requested and reviewed 

documentation for savings to beneficiaries and others that were attributable to the projects, as 

well as documentation for cost avoidance. We have provided the results of the current

performance measures in detail in the appendixes.

Standards

This study was conducted in accordance with the Quality Standards for Inspection and 

Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency.

RESULTS

Results for 2015

In 2015, the SMP projects reported $2.5 million in expected Medicare recoveries that were 

attributable to their projects. Almost all of these recoveries resulted from one project’s efforts, 

which led to the conviction of a hospice company owner for Medicare fraud. Expected Medicare

recoveries in 2015 increased by 282 percent from $660,829 in 2014.3In 2015, the projects did 

not report any expected Medicaid recoveries; in 2014, they reported $504.

In 2015, the projects reported a total of $35,059 savings to beneficiaries and others. This was a 

56 percent decrease from $80,228 in 2014. The majority of the savings reported in 2015 was the 

result of one project’s efforts involving four separate beneficiary complaints pertaining to one

provider. The provider had charged the beneficiaries for monthly treatments when Medicare 

covered these treatments. The SMP project helped the beneficiaries obtain refunds from the 

provider. In addition, the projects reported a total of $21,533 in cost avoidance on behalf of 

______________________________________________________________________________

2

In June 2015, the SMP projects in Florida, Mississippi, Nebraska, New York, and South Dakota were replaced by 

new grantees. In addition, West Virginia did not have an SMP project in 2014; a new grantee began in June 2015.

3 Expected Medicare and Medicaid recoveries may vary widely from year to year depending on the number and 

nature of the cases that are resolved each year. In 2014, expected Medicare and Medicaid recoveries were $661,333; 

in 2013, they were $9.1 million.
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Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190)

Medicare, Medicaid, beneficiaries, and others. This was a substantial decrease of 89 percent

from $200,598 in 2014. 

Results Since 1997

Since the program’s inception 18 years ago, 72 SMP projects have reported performance data. In 

total, expected recoveries to Medicare and Medicaid attributable to the projects amounted to

$117.6 million.4 Most of the recoveries resulted from one project’s involvement in adjustments to 

Medicaid claims for individuals entitled to both Medicare and Medicaid.

5

 Total savings to 

beneficiaries and others were approximately $7 million. Finally, total cost avoidance on behalf 

of Medicare, Medicaid, beneficiaries, and others was $9 million. 

CONCLUSION

The SMP projects receive grants from ACL to recruit and train retired professionals and other 

senior citizens to recognize and report instances or patterns of health care fraud. In 2015, results

attributable to their efforts included $2.5 million in expected Medicare recoveries and total 

savings to beneficiaries and others of $35,059. 

We continue to emphasize that the projects may not be receiving full credit for recoveries, 

savings, and cost avoidance attributable to their work. It is not always possible to track referrals 

to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, 

waste, and abuse from the projects. In addition, the projects are unable to track the potentially 

substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of 

their bills reduce fraud and errors.

We are issuing this memorandum report in final form because it contains no recommendations. 

If you have comments or questions about this memorandum report, please provide them within 

60 days. Please refer to report number OEI-02-16-00190 in all correspondence. 

cc:

Kathleen Cantwell

Director of the Office of Strategic Operations and Regulatory Affairs

Centers for Medicare & Medicaid Services

______________________________________________________________________________

4 Prior to 2007, OIG reviewed documentation on savings to Medicare only and included self-reported data on 

savings to Medicaid, beneficiaries, and other entities. In addition, prior to 2012, the projects reported only actual 

recoveries.

5 The project reported these savings between 2001 and 2003.
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 5

Results for Performance Measures

for the Senior Medicare Patrol Projects

List of Appendixes

Appendix A: Summary of Overall Performance of Projects Since 1997..........................................6

Appendix B: Summary of Overall Performance of Projects in 2015.................................................7

Appendix C: Results for 2015, by Performance Measure..............................................................8

Appendix D: Results for 2015, by Project............................................................................. 14

Appendix E: Definitions of Performance Measures................................................................. 33
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 6

APPENDIX A

Summary of Overall Performance of Projects Since 1997

PERFORMANCE MEASURES Total Since 1997

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others* $9,061,320

Expected Medicare recoveries attributable to the projects** $22,831,091

Expected Medicaid recoveries attributable to the projects** $94,812,297

Actual savings to beneficiaries attributable to the projects $3,531,853

Other savings attributable to the projects (e.g., Supplemental Insurance) $3,472,002

Total savings attributable to the projects *** $124,647,243

 * Performance measure was reported as of 2007.

 ** Performance measure was changed to include actual and expected recoveries as of 2012. Prior to 2012, the 

measure only included actual recoveries. 

*** Total savings does not include cost avoidance.
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 7

APPENDIX B

Summary of Overall Performance of Projects in 2015

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $21,533

Expected Medicare recoveries attributable to the projects $2,525,838

Expected Medicaid recoveries attributable to the projects $0

Actual savings to beneficiaries attributable to the projects $34,921

Other savings attributable to the projects (e.g., Supplemental Insurance) $138

Total savings attributable to the projects * $2,560,898

* Total savings does not include cost avoidance.
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 8

APPENDIX C

Results for 2015, by Performance Measure

The following tables provide the results by performance measure for each of the 54 Senior Medicare Patrol 

projects.

Note: The total amounts for some performance measures may not match the sum of each of these performance 

measures in Appendix B because of rounding. 
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 9

Cost Avoidance on Behalf of Medicare, Medicaid, Beneficiaries, or Others

Total for 2015 Total for 2015

Alabama $0 Montana $0

Alaska $0 Nebraska $0

Arizona $0 Nevada $0

Arkansas $658 New Hampshire $0

California $3,585 New Jersey $46

Colorado $2,115 New Mexico $0

Connecticut $0 New York $0

Delaware $0 North Carolina $0

District of Columbia $0 North Dakota $0

Florida $85 Ohio $5,353

Georgia $0 Oklahoma $0

Guam $0 Oregon $0

Hawaii $0 Pennsylvania $0

Idaho $0 Puerto Rico $0

Illinois $0 Rhode Island $0

Indiana $0 South Carolina $0

Iowa $544 South Dakota $0

Kansas $0 Tennessee $225

Kentucky $0 Texas $0

Louisiana $850 U.S. Virgin Islands $0

Maine $701 Utah $6,180

Maryland $0 Vermont $0

Massachusetts $0 Virginia $0

Michigan $0 Washington $0

Minnesota $0 West Virginia $0

Mississippi $0 Wisconsin $0

Missouri $0 Wyoming $1,192
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 10

Expected Medicare Recoveries Attributable to the Projects

Total for 2015 Total for 2015

Alabama $0 Montana $0

Alaska $92 Nebraska $0

Arizona $0 Nevada $0

Arkansas $0 New Hampshire $0

California $1,431 New Jersey $0

Colorado $293 New Mexico $0

Connecticut $0 New York $0

Delaware $1,916 North Carolina $0

District of Columbia $0 North Dakota $0

Florida $0 Ohio $0

Georgia $0 Oklahoma $2,519,813

Guam $0 Oregon $0

Hawaii $40 Pennsylvania $0

Idaho $0 Puerto Rico $0

Illinois $0 Rhode Island $0

Indiana $0 South Carolina $0

Iowa $0 South Dakota $0

Kansas $0 Tennessee $0

Kentucky $104 Texas $0

Louisiana $0 U.S. Virgin Islands $0

Maine $0 Utah $0

Maryland $0 Vermont $0

Massachusetts $0 Virginia $0

Michigan $0 Washington $0

Minnesota $0 West Virginia $0

Mississippi $0 Wisconsin $0

Missouri $0 Wyoming $2,148
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 11

Expected Medicaid Recoveries Attributable to the Projects

Total for 2015 Total for 2015

Alabama $0 Montana $0

Alaska $0 Nebraska $0

Arizona $0 Nevada $0

Arkansas $0 New Hampshire $0

California $0 New Jersey $0

Colorado $0 New Mexico $0

Connecticut $0 New York $0

Delaware $0 North Carolina $0

District of Columbia $0 North Dakota $0

Florida $0 Ohio $0

Georgia $0 Oklahoma $0

Guam $0 Oregon $0

Hawaii $0 Pennsylvania $0

Idaho $0 Puerto Rico $0

Illinois $0 Rhode Island $0

Indiana $0 South Carolina $0

Iowa $0 South Dakota $0

Kansas $0 Tennessee $0

Kentucky $0 Texas $0

Louisiana $0 U.S. Virgin Islands $0

Maine $0 Utah $0

Maryland $0 Vermont $0

Massachusetts $0 Virginia $0

Michigan $0 Washington $0

Minnesota $0 West Virginia $0

Mississippi $0 Wisconsin $0

Missouri $0 Wyoming $0
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 12

Actual Savings To Beneficiaries Attributable to the Projects

Total for 2015 Total for 2015

Alabama $0 Montana $0

Alaska $0 Nebraska $0

Arizona $0 Nevada $0

Arkansas $0 New Hampshire $0

California $41 New Jersey $1,580

Colorado $0 New Mexico $0

Connecticut $0 New York $0

Delaware $0 North Carolina $0

District of Columbia $0 North Dakota $0

Florida $0 Ohio $0

Georgia $0 Oklahoma $0

Guam $0 Oregon $760

Hawaii $0 Pennsylvania $0

Idaho $0 Puerto Rico $0

Illinois $0 Rhode Island $0

Indiana $0 South Carolina $0

Iowa $0 South Dakota $0

Kansas $0 Tennessee $40

Kentucky $28,500 Texas $0

Louisiana $0 U.S. Virgin Islands $0

Maine $0 Utah $1,692

Maryland $0 Vermont $0

Massachusetts $0 Virginia $0

Michigan $0 Washington $0

Minnesota $0 West Virginia $0

Mississippi $0 Wisconsin $0

Missouri $0 Wyoming $2,308
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 13

Other Savings Attributable to the Projects

Total for 2015 Total for 2015

Alabama $0 Montana $0

Alaska $0 Nebraska $0

Arizona $0 Nevada $63

Arkansas $0 New Hampshire $0

California $0 New Jersey $0

Colorado $75 New Mexico $0

Connecticut $0 New York $0

Delaware $0 North Carolina $0

District of Columbia $0 North Dakota $0

Florida $0 Ohio $0

Georgia $0 Oklahoma $0

Guam $0 Oregon $0

Hawaii $0 Pennsylvania $0

Idaho $0 Puerto Rico $0

Illinois $0 Rhode Island $0

Indiana $0 South Carolina $0

Iowa $0 South Dakota $0

Kansas $0 Tennessee $0

Kentucky $0 Texas $0

Louisiana $0 U.S. Virgin Islands $0

Maine $0 Utah $0

Maryland $0 Vermont $0

Massachusetts $0 Virginia $0

Michigan $0 Washington $0

Minnesota $0 West Virginia $0

Mississippi $0 Wisconsin $0

Missouri $0 Wyoming $0
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 14

APPENDIX D

Results for 2015, by Project

The following tables provide a project-by-project listing of the results for each performance measure for each of 

the 54 Senior Medicare Patrol projects in 2015. The measure for total savings does not include cost avoidance. 

In addition, the tables include the grant total, which is the total amount that each project received in 2015.
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 15

Alabama – Department of Senior Services, Montgomery

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $268,341

Alaska – Health and Social Services, Medicare Information Office, Anchorage

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $92

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $92

Grant Total: $224,200

Arizona –Division of Aging and Adult Services, Phoenix

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $273,334
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 16

Arkansas –Department of Human Services, Division of Aging and Adult Services, Little 

Rock

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $658

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $251,265

California – California Health Advocates, Santa Ana

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $3,585

Expected Medicare recoveries attributable to the project $1,431

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $41

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $1,472

Grant Total: $483,831

Colorado – Colorado Department of Regulatory Agencies, Division of Insurance, Denver

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $2,115

Expected Medicare recoveries attributable to the project $293

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $75

Total savings attributable to the project $368

Grant Total: $257,369
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 17

Connecticut – Connecticut Department of Social Services, Aging Services Division, 

Hartford

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $250,017

Delaware – Delaware Division of Services for Aging and Adults with Physical 

Disabilities, New Castle

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $1,916

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $1,916

Grant Total: $228,848

District of Columbia – AARP Legal Counsel for the Elderly, Washington, DC

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $224,071
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 18

Florida – eQHealth Solutions, Baton Rouge, LA *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $85

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $407,689

* New grantee in 2015

Georgia – GeorgiaCares, Atlanta

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $295,672

Guam – Department of Public Health & Social Services, Division of Senior Citizens, 

Mangilao

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $93,431
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 19

Hawaii –Executive Office on Aging, Honolulu

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $40

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $40

Grant Total: $232,054

Idaho – Idaho Commission on Aging, Boise

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $234,603

Illinois – AgeOptions, Oak Park

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $320,960
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 20

Indiana – Indiana Association of AAAs, IAAA Education Institute, Indianapolis

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $277,238

Iowa – Northeast Iowa AAA, Waterloo

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $544

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $250,161

Kansas – Department for Aging and Disability Services, Topeka

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $245,008
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 21

Kentucky – Louisville Metro Department of Public Health & Wellness, 

Louisville

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $104

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $28,500

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $28,604

Grant Total: $269,811

Louisiana – eQHealth Solutions, Baton Rouge

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $850

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $258,963

Maine – Legal Services for the Elderly, Augusta

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $701

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $236,381
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 22

Maryland – Maryland Department of Aging, Baltimore

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $264,099

Massachusetts – Elder Services of the Merrimack Valley, Inc., Lawrence

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $277,489

Michigan – MMAP, Inc., Lansing

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $313,037
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 23

Minnesota – Minnesota Board of Aging, Dept. of Human Services, Aging and Adult 

Services Div., Saint Paul

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $265,721

Mississippi – eQHealth Solutions, Baton Rouge, LA *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $249,980

* New grantee in 2015

Missouri – Care Connection for Aging Services, Warrensburg

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $277,318
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 24

Montana – Missoula Aging Services, Missoula

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $230,678

Nebraska – Nebraska SHIP, Lincoln *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $236,224

* New grantee in 2015

Nevada – Division of Aging and Disability Services, Las Vegas

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $63

Total savings attributable to the project $63

Grant Total: $241,102
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 25

New Hampshire – Health and Human Services – Bureau of Elderly & Adult Services, 

Concord

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $233,449

New Jersey – Jewish Family & Vocational Services of Middlesex County, Inc., Milltown

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $46

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $1,580

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $1,580

Grant Total: $288,950

New Mexico – Aging and Long-Term Services Department, Santa Fe 

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $238,716
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 26

New York –Services and Advocacy for GLBT Elders, New York *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $379,921

* New grantee in 2015

North Carolina – Department of Insurance, Raleigh

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $308,490

North Dakota – North Dakota Center for Persons with Disabilities, Minot

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $226,198
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 27

Ohio – Pro Seniors, Inc., Cincinnati

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $5,353

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $325,128

Oklahoma – Oklahoma Insurance Department, Oklahoma City

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $2,519,813

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $2,519,813

Grant Total: $254,642

Oregon – Department of Human Services, Seniors & People with Disabilities, Salem

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $760

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $760

Grant Total: $257,102
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 28

Pennsylvania – Center for Advocacy for the Rights and Interests of the Elderly, 

Philadelphia

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $343,230

Puerto Rico –Ombudsman Office for the Elderly, Santurce

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $256,546

Rhode Island – Department of Human Services, Division of Elderly Affairs, Cranston

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $229,489
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 29

South Carolina – Lt. Governor’s Office on Aging, Columbia

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $266,260

South Dakota – Department of Social Services, Division of Adult Services and Aging, 

Pierre *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $228,228

* New grantee in 2015

Tennessee – Upper Cumberland Development District, Cookeville

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $225

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $40

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $40

Grant Total: $282,160
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 30

Texas – Better Business Bureau Education, Houston

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $394,572

U.S. Virgin Islands – Senior Citizens Affairs, St. Croix

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $75,000

Utah – Utah Division of Aging and Adult Services, Salt Lake City

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $6,180

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $1,692

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $1,692

Grant Total: $236,864
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 31

Vermont – Community of Vermont Elders, Berlin

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $227,109

Virginia – Virginia Association of Area Agencies on Aging, Richmond

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $286,589

Washington – Office of the Insurance Commissioner, Tumwater

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $277,174
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 32

West Virginia – Bureau of Senior Services, Charleston *

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $242,072

* New grantee in 2015

Wisconsin – Coalition of Wisconsin Aging Groups, Madison

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $0

Expected Medicare recoveries attributable to the project $0

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $0

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $0

Grant Total: $272,900

Wyoming – Senior Citizens, Inc., Riverton

PERFORMANCE MEASURES Total for 2015

Cost avoidance on behalf of Medicare, Medicaid, beneficiaries, or others $1,192

Expected Medicare recoveries attributable to the project $2,148

Expected Medicaid recoveries attributable to the project $0

Actual savings to beneficiaries attributable to the project $2,308

Other savings attributable to the project (e.g., Supplemental Insurance) $0

Total savings attributable to the project $4,456

Grant Total: $225,040
Performance Data for the Senior Medicare Patrol Projects: June 2016 Performance Report (OEI-02-16-00190) 33

APPENDIX E

Definitions of Performance Measures

COST AVOIDANCE Health care expenditures for which the Government, a beneficiary, or 

other entity (e.g., secondary health insurer or a pharmacy) was relieved of 

responsibility for payment as a result of the SMP project. 

EXPECTED MEDICARE This amount represents actual and expected recoveries 

RECOVERIES from criminal actions, settlements, civil judgments, or overpayments that 

resulted from the referral. This applies to the amount of money that was 

ordered or agreed upon to be returned to Medicare, and may not reflect 

actual collections. Recoveries may also involve cases that include 

participation by a Medicare contractor or a law enforcement agency. 

EXPECTED MEDICAID This amount represents actual and expected recoveries 

RECOVERIES from criminal actions, settlements, civil judgments, or overpayments that 

resulted from the referral. This applies to the amount of money that was 

ordered or agreed upon to be returned to Medicaid, and may not reflect 

actual collections. Recoveries may also involve cases that include 

participation by a Medicaid Fraud Control Unit or a law enforcement 

agency. 

SAVINGS TO THE Money saved by or recouped to an individual as a result of 

BENEFICIARY the SMP project (e.g., copayments, deductibles, or any other out-of-pocket 

expenses). 

OTHER SAVINGS Money saved or recouped to an entity other than Medicare, Medicaid, or a 

beneficiary (e.g., secondary health insurer) as a result of the SMP project.