For Professionals: Medicare Fraud and Abuse

Successful Strategies in Reaching Hmong Elders: A Case Study in Medicare Fraud Outreach

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Published: Apr 8, 2011

Getting the message out on preventing, detecting and reporting Medicare fraud is key for protecting the integrity of the Medicare program, as well as the benefits and wellbeing of Medicare beneficiaries. And getting this message out to beneficiaries who don’t speak English, or have limited English proficiency in particular, is even more important as they are often considered easy targets for scam artists. This is one reason why Marta Erismann, our Senior Medicare Patrol (SMP) Community Outreach Coordinator, and Michelle Lee, a registered Health Insurance Counseling & Advocacy Program (HICAP) volunteer counselor have teamed together to reach out to Hmong elders. Earlier this year they presented to a group of over 120 Hmong elders in Fresno, the city with the largest Hmong population in the state with 25,000 residents. They also recently presented in Sacramento, the city with the 2nd largest Hmong population with close to 18,000 Hmong residents.

Reaching this population presents some unique challenges. A large percentage of Hmong elders do not read or write. In addition, many elders stay close to home.

Reaching this population presents some unique challenges. A large percentage of Hmong elders do not read or write. In addition, many elders stay close to home. Besides attending family functions, going to doctor’s appointments, or participating in events at a nearby Hmong church or community center, many elders prefer to be home. This means that just getting Medicare publications translated in Hmong and distributing them at local senior centers, and/or giving presentations at local senior centers on Medicare fraud will not get the message to this population.

Erismann and Lee planned accordingly in their outreach and education. For example, Lee used to work at the Hmong Women’s Heritage Association, a non-profit that the Sacramento Hmong community trusts. Her association with them automatically gave her a credible “listening” from the community. Also, being Hmong herself, she could orally present the Medicare fraud information in their native tongue. In addition, while Erismann and Lee did translate some materials (such as the Hmong version of the anit-fraud cartoon brochure), these were materials with a high ratio of pictures to text.

The Presentation

Erismann and Lee started their presentation by reviewing 3 cards that each Hmong woman present (mainly women in their 30s and 40s, a few over 50) knew and recognized. These were the Medi-Cal, Medicare and Social Security cards. Lee reviewed what these cards are, why they are important, what benefits they entitle one to and the importance of protecting these cards. Most of these women were on Medi-Cal only, yet they recognized the red, white and blue Medicare cards as most of their parents have them. Many women asked, since Medicare generally costs more than full Medi-Cal, why it was necessary for their parents? Lee explained that having Medicare often means having more doctors and facilities to choose from (as more physicians accept Medicare than just Medi-Cal) and subsequently better access to quality care.

They reviewed the benefits of Medicare and then gave several examples of common fraud scenarios and how to respond to such situations. Many women were surprised to hear how prevalent fraud is and began sharing their own stories.

Cases of Fraud

One woman told how her doctor required her to come into the office every month, regardless of whether she was sick. He threatened to “kick her out” of his practice if she missed more than 2 visits. Another woman shared how she had been approached by a stranger asking for her Medicare number. Fortunately she declined to give it, as she knew protecting her number was important. And another lady warned the group to be careful with their Social Security cards/numbers too. One of her sons had his Social Security number stolen. They found out because her 12 year old son started getting Social Security earning reports, yet he wasn’t working. Someone had stolen his number and then secured employment.

Lee made sure to explain repeatedly that it is both okay and essential to report such cases. She stressed that any report to their local SMP program is completely confidential. In general, many Hmong people, similar to other populations, have been taught not to question elders and/or people in positions of authority. Many people see their doctors and health care providers as figures of authority and are therefore reluctant to report suspicious fraudulent activity, even if they know it’s wrong.

Tips for Collaboration

First, any message you have for the Hmong community must be delivered orally in their own language. You can have some supportive translated materials, yet as a large percentage of the Hmong population don’t read or write, the “meat” of the message should be delivered verbally. It’s also best for the presenter to be familiar with both Medicare and Medicaid so that s/he can answer questions on these 2 programs. Radio interviews, public service announcements (PSAs) and TV commercials and PSAs are also good ways to get the message out.

Second, it’s important to work through a person, organization, church or center trusted by the local Hmong community. They can point you to additional resources and organizations with which to form partnerships and collaborations. Below are some recommended organizations to collaborate with in 4 California cities with the largest Hmong populations in the state, Fresno, Sacramento, Merced and Stockton. There are also a couple nationwide organizations listed.

For more information on Medicare fraud and/or our California SMP program, see our website.

We also have a list of resources, including the Hmong translated anti-fraud brochure mentioned above, a fraud fact sheet, and links to short video PSAs on fraud, fraud prevention, reporting and volunteer opportunities with the SMP program. For any fraud related questions, reporting or SMP volunteer inquiries, call our California SMP helpline at (855) 613-7080. You can also visit us on Facebook.

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