Fraud/Abuse Specialist

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The New York Senior Medicare Patrol (SMP) is part of a nationwide campaign to educate Medicare beneficiaries about healthcare fraud. Our mission is to reduce fraud by empowering beneficiaries to prevent, detect and report Medicare errors and abuse. We want to ensure that older adults do not have to fall victim to this abuse.

SMP Volunteer Complex Interactions Specialist

Volunteers who handle complex issues work individually with beneficiaries to report specific instances of suspected health care fraud, error and abuse. They help beneficiaries distinguish error from potential fraud or abuse and act on the beneficiary's behalf to correct errors and refer suspected fraud and abuse to the appropriate authorities.

Volunteers who handle complex issues respond to beneficiary and caregiver inquiries that involve complaints of fraud, error, and abuse by:

• Interviewing the beneficiary and/or caregiver in person or by telephone
• Researching issues using SMP manuals and other Medicare program integrity resources
• Providing completed complex issues form and associated documentation of suspected fraud, error, or abuse to SMP headquarters to be reported in the SMART FACTS reporting and referrals system and for reporting to the appropriate government entity for investigation
• Assessing the case for further investigation and/or referral
• Supporting and following up with beneficiaries as their reported issue moves through the investigation and resolution process

Qualifications

• Research and case management skills
• Ability and willingness to learn and share information related to preventing, detecting, and reporting health care billing mistakes, fraud, and abuse
• Ability to follow case referral protocols
• Ability to work independently
• Computer literacy, including ability to use the Internet and on line reporting programs

Time Commitment: Volunteer schedules are flexible. The Volunteer Coordinator works with each volunteer to determine the number of hours the volunteer works each month, and to schedule assignments accordingly. Because of the training SMP volunteers receive, they are asked to commit to a minimum of one year.

Training/Support: All New York SMP volunteers receive training on the SMP program, Medicare Basics, and Medicare Fraud and Abuse. Volunteers will also be invited to attend update trainings made available by the New York SMP program or other program partner agencies.