Executive Summary

The National Hispanic Council on Aging (NHCOA) conducted a needs assessment on Medicare Fraud in Texas in 2008. The needs assessment is the first of five to be carried out in five different states with high Hispanic populations, as part of the National Hispanic SMP Program funded by the US Administration on Aging (AoA).

The needs assessment in Texas was implemented in three key components: a literature review, a survey of key organizations serving the Hispanic community, and a series of four community forums held in Dallas, El Paso, Houston, and McAllen. The survey collected quantitative information and the community forums collected qualitative information. The goal of the assessment was twofold: (1) to explore the needs, as they relate to access to Medicare fraud information, of Hispanic older adults and the organizations that serve them in the state of Texas; and (2) to create systems and tools that will allow NHCOA to connect resources with providers and community members in a culturally-, linguistically-, and age-sensitive manner.

Key findings from the assessment include:

• Fraud is a widespread problem in the Hispanic older adult community.
• The most common types of fraud and abuse were double-billing for services already paid by Medicare or billing for services that were never performed, as well as durable medical equipment (DME), and home health.
• 78% of abuse or fraud cases are perpetrated through unsolicited house visits and/or calls by salespeople.
• There is a dearth of information available on Medicare fraud in Spanish. Most Hispanic older adults who participated in the assessment said that they did not have information available on Medicare fraud, and those who have been exposed to any type of information said that they did not understand it because it was too complicated.
• Older Hispanic adults feel frightened, isolated, and misunderstood. They do not understand the majority of materials on Medicare even when they are in Spanish, because the materials are not age- nor culturally-appropriate.
• The biggest challenges participants reported regarding Medicare fraud include language, fear, and culture.
• There is a great disconnect between resources available on Medicare fraud and the Hispanic older adult community, and this disconnect goes beyond language. Some agency outreach personnel who speak Spanish may not necessarily be able to bridge the cultural and generational gap with older Hispanic adults, making them unable to reach them successfully, while staff of local community-based organizations and promotores used in the local SMP in the Rio Grande Valley are able to reach older Hispanic adults with messages. Their program is resulting in reporting of fraud.

The National Hispanic Council on Aging (NHCOA) hopes to be able to gather valuable information to share with the 54 SMPs and other organizations, so they can they can expand their efforts to include Hispanic older adults and help meet the demands of our large and diverse older adult population.