Pilot Program Fights Fraud in the Hispanic Community

Replication planned for other vulnerable populations

By María Eugenia Hernández-Lane, MSM/MBA
Vice President, National Hispanic Council on Aging

A new pilot program funded by the U.S. Administration on Aging (AoA) in September 2008 is taking up the fight against Medicare fraud on behalf of the nation’s older Hispanic Americans. The National Hispanic Council on Aging’s (NHCOA’s) National Hispanic Senior Medicare Patrol (NHSMP) is an innovative program working to develop a model that would close the gap in Medicare fraud education between Hispanic older adults and mainstream populations.

The program aims to reach and serve the hard-to-reach older Hispanic adult population through community-based programs already serving this population in five diverse Hispanic communities across the United States. It will provide technical assistance and education to these community-based organizations while promoting collaboration between local stakeholders and finding ways to establish program sustainability. A major focus is to find the common needs among communities in relation to Medicare fraud prevention, detection and reporting and to develop consistent tools and materials for dissemination nationwide. AoA and NHCOA believe the program will prove easy to replicate on behalf of other vulnerable groups in the United States.

AoA has long recognized that Medicare fraud is one of the most serious problems facing U.S. older adults. Taking many forms, Medicare fraud not only costs the U.S. government millions of dollars each year, it also squeezes the funds of some of the nation’s most vulnerable citizens –defrauding them of money that should go to food, housing and legitimate health care expenses. Worse, those older adults most likely to fall prey to fraud are also those who have limited retirement monies or are poor, have lower formal education levels, are limited-English proficient and have few culturally and linguistically competent sources of advice and support. The Hispanic older adult population has a high level of all these risk factors, making it the population most in need of a program like NHSMP. It’s also one of the populations least likely to recognize Medicare fraud and to know how to report it without intervention.

Hispanic older adults are a notoriously difficult population to successfully reach and serve. Many efforts to serve them have included translating outreach and education materials into Spanish. Simply translating materials, however, has not been found to be very effective with Hispanic older adults. Translated materials often do not address cultural presumptions among Hispanic adults in reference to the material at hand or they may assume a greater understanding of the Medicare and U.S. health care system than many Hispanic older adults possess.

The task of successfully reaching and serving Hispanic older adults has gained critical importance with the rapid growth of the Hispanic older adult community. One of the fastest growing population groups in the nation, it is expected to comprise more than 11 percent of the entire older adult population by 2030. NHCOA, with more than 30 years of experience, is the national expert in reaching and serving Hispanic older adults.

Born from a highly successful NHCOA SMP implemented in the state of Texas, the NHSMP builds on its years of experience to reach out to SMPs across the country that serve Hispanic older adults and their families. The focus of NHSMP technical assistance to SMPs will revolve around culturally and linguistically appropriate ways to help older Hispanic adults detect and report Medicare fraud. The NHSMP also will continue its outreach work in the Rio Grande Valley.

A key component of the NHSMP program is the community comprehensive needs assessment. The assessment, designed to be carried out in states with high Hispanic populations, seeks to learn the unique characteristics and needs of each community. The first step in the needs assessment is a literature review that gathers information on local organizations servicing Hispanic seniors and on the resources currently available on Medicare fraud, detection and reporting. The second step is the implementation of a survey of community stakeholders – community organizations serving Hispanic older adults, organizations implementing SMPs, health care workers and categories of individuals. The third and final step of the assessment is in organizing open-participation community forums that bring together local stakeholders, including local groups, community leaders and Hispanic families, to discuss the problems of Medicare fraud and abuse in their communities. The findings of the assessment guide the development of effective tools and strategies for the provision of technical assistance to community-based organizations engaging in SMP work

To date, the needs assessments have been carried out with the assistance of NHCOA’s partner affiliate in the Rio Grande Valley: Senior Community Outreach Services (SCOS). In the course of the first program year, these needs assessments will be implemented in the Texas counties of El Paso, Pharr and Dallas and in the Houston metropolitan.