HLOL Podcast Transcripts

Health Literacy

Communicating About Potential Healthcare Fraud and Abuse (HLOL #232)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

We all are at risk for healthcare fraud and abuse. The consequences of this can be steep, such as losing medical benefits, experiencing physical harm or even being the victim of identity theft.

Nicole Liebau knows a lot about ways to help. She’s Director of the Senior Medicare Patrol, or SMP, National Resource Center at the Northeast Iowa Area Agency on Aging, Inc.

There are over 50 SMP projects across the United States that focus on issues of Medicare fraud, outreach and education.

I had the great honor of working with Nicole and others to present some webinars about the connection between their important work and health literacy.

Nicole, welcome to Health Literacy Out Loud.

Nicole Liebau: Thank you, Helen. It’s so great to be here today, and it’s been a pleasure working with you as well in those webinars that we presented recently. They were really great for our network, and we just really appreciate the additional education to assist. Thank you so much for having me.

Helen Osborne: Oh, good. Now we’re doing it in a different way. This way, you get to speak to my people.

My people, the listeners of Health Literacy Out Loud, can be from the US, from anywhere in the world, not always just the US. We can be clinicians. We might be in public health, community organizations or libraries. We can come from whatever perspectives we want. What we all have in common is we all want to communicate a bit better today than we did yesterday.

I wanted to talk with you about how you communicate about issues of potential healthcare fraud and abuse. It’s a topic I read about in the paper, but I’ve never focused on in these podcasts. It seems so rife. I’m always reading about these awful things that can happen.

Can you take it from the beginning and tell us when you use the terms healthcare fraud and abuse, what are you talking about? Who does it affect? Why is it a problem? Just start from the beginning, please.

Nicole Liebau: Helen, I think you hit the nail on the head right away. It really does affect everyone. There is a little bit of a difference between potential healthcare fraud and then the abuse side.

The fraud piece is really knowing and intentionally having someone, like a scammer, sending in false claims or misrepresentation of somebody’s healthcare, and billing their healthcare for those items intentionally.

Helen Osborne: I know you work primarily with a Medicare audience, but as I said, listeners can be from anywhere in the world. Not everyone has Medicare. Is fraud just an issue of Medicare and Medicare billing, the way we have it in the United States, or is that a universal problem?

Nicole Liebau: I think overall it can be a universal issue. As we specifically deal with Medicare fraud and Medicare beneficiaries, I think there are some common themes for healthcare fraud. Some of those could include medically unnecessary tests, treatments, equipment, services or even prescriptions.

One of the things that you had mentioned as well is just medical identity theft. Sometimes somebody’s medical identity could be worth more to a scammer than a credit card, because it can be used again and again.

Helen Osborne: Can you give us an example? I know that this is a term you use all the time, but make it real. Tell us a story. How does someone take someone’s medical identity and steal it? What do they do with it? Tell us more.

Nicole Liebau: One example of how someone may get your medical identity is to call you. They might cold-call you. In our work, they could impersonate Medicare or a government agency and ask for your personal information. Then that’s how they receive it, is really by tricking somebody into thinking they’re somebody that they’re not.

It could also be that they get your medical identity, but then they also use it for, again, billing for things that they may never receive.

Sometimes it can be worth more than a credit card just because it can be used again and again without it being shut off right away like a credit card could be.

Helen Osborne: Medicare recipients, for those who are not from the US, are people who are older. Are we more vulnerable, or could this happen if it’s not by Medicare that someone gets your medical identity somehow?

Is everyone equally vulnerable to those phone calls saying, “I have your identity,” or, “You need to pay this bill,” even if it’s false?

Nicole Liebau: I wouldn’t say equally necessarily.

Again, I come from that Medicare purview or scope overview of fraud. I think, again, we’re all really at risk, but the unique part that makes Medicare recipients a little bit more at risk would be that they are 65 and older. They are older adults, and they usually have more medical needs that need to be met.

That can also affect that exposure piece of falling for a scheme or falling for that call, especially since Medicare in the US is nationwide.

Really, those cold calls just state they’re from the Social Security Administration or from Medicare, because those are national. It’s a blanket type of scheme to get people to divulge personal information.

Helen Osborne: I think what you just said, the words “divulge their personal information,” I just got an email out of the blue saying, “We’re going to renew your thing you signed up for last year. We’ll use your credit card.” But it’s nothing I ever signed up for.

My sense is if I responded to that, they would have then asked me for my credit card information and then taken it from there.

Nicole Liebau: That’s a really good example, too, of a type of scheme. People use anything just to get more information out of the person or get them to click on something online. Then they go as far as they can to continue to get more information if they’re able. I think that’s a really good example as well.

Helen Osborne: Boy, when I read those articles in the news and see them on TV, one, I’ll be grateful if it’s not me or somebody that I know, and, two, I want to figure out what to do. I’ll be thinking of what you’re talking about now.

The group that you work with has a lot to do about informing the public about preventing, detecting and reporting possible fraud and abuse.

I’d love it, Nicole, if you can share with all our listeners how all of us can be helping the people we care for and care about to prevent, detect and report possible fraud and abuse.

Nicole Liebau: I think the first thing that we try to do, especially our program, and this goes for any type of fraud, is prevent it from happening in the first place.

Really, to do that, we need to get those resources and the information out to show people the red flags of different types of fraud and how they can protect themselves and their loved ones.

The first thing is really the education piece, which goes with the outreach and the materials that we can provide people.

Talking to your neighbor, talking to communities, talking to anyone, you can spread that message of prevention. That’s the best way to prevent something from happening.

Helen Osborne: Just like you’re teaching all of us even on this podcast what it is, for all of us to go out and talk with other people we know, like, “Here are some examples. Here are some bad things that can happen”?

Nicole Liebau: Yes. Again, we can talk about that, too, about protecting your medical identity, treating it like a credit card, treating it like any of your personal numbers that you may have. That is so important. I think that’s one of the biggest things.

Then knowing how to detect it. Specifics of a Medicare beneficiary, one thing that we have that we teach everyone is, “Go read your Medicare summary notices.” The equivalent to that for anyone else with healthcare would be an explanation of benefits.

Helen Osborne: The EOB.

Nicole Liebau: Yes.

Helen Osborne: Which just looks like more paperwork. It says, “This is not a bill,” and it’s got all this stuff all over it. That’s actually important to pay attention to?

Nicole Liebau: It is important to pay attention to because it’s telling you what is billed. If there’s anything inconsistent on that, whether you have Medicare or any type of other healthcare plan, it’s important to review those to make sure that is the day you went to the doctor, you did receive that back brace and those things did happen on that day.

We use My Health Care Tracker. It’s a resource we provide through our program, but it can apply to anyone, really. It is what the name of it is. It’s tracking your healthcare and just writing down when you go to the doctor, when you go to the pharmacy, when you pick up a prescription, those things.

Write that down and then you can compare it to those healthcare statements. That helps detect anything that should happen that you could report.

It could even be an error. Sometimes your healthcare provider just makes an error. I think that’s why I went back to defining what fraud really was. It’s that intentional piece.

Helen Osborne: Oh, okay. That’s different from just an error.

Nicole Liebau: Yes. Fraud is the actual intent to harm. They’re a scammer. They’re the ones out there intentionally stealing people’s information, etc. But then some of this could just be errors. If you review your healthcare statements, that can really help bring some of that to light.

Helen Osborne: Thank you. I don’t do this as often, but I used to keep the receipts when I’d buy something and then I’d look at my credit card information every week or two and compare them. Were they the same? It sounds like it’s a similar kind of a process, just verifying information.

These are great tips about preventing and detecting. I know that you’re also focused on reporting possible fraud and abuse. That sounds even harder. Tell us more about that.

Nicole Liebau: If you were to have something happen where you needed to report abuse, again, our Senior Medicare Patrol program is specific to Medicare fraud, errors and abuse.

We have SMPs, as Helen had mentioned, around the country in all 50 states, District of Columbia, Guam, Puerto Rico and the Virgin Islands. That can be reported to them if it’s specific to Medicare.

There are other places, depending on your health insurance, where you can report those. Again, we try to do our best at the Senior Medicare Patrols to get you where you need to go, even if it’s not specific to Medicare.

Helen Osborne: Nicole, for people who are listening, if someone is suspicious or thinks there is a potential problem, can they start with some of the links you’re talking about?

Nicole Liebau: Yes. I think the first thing we really tell people to do regardless is to call your provider.

Helen Osborne: Call your healthcare provider?

Nicole Liebau: Call them first. That’s always the best thing to do, because we talked about errors, and it’s best to just see if that’s the case.

Then I think that’s where you go and find your next step. That can mean different things.

Obviously, our Medicare program here is a little bit different than a private healthcare plan that you may have through a company or employer. There are different places in each state that you are able to report that.

Helen Osborne: Will you give us some resources that will be on your Health Literacy Out Loud web page?

Nicole Liebau: Yes. I will make sure those links are provided for everyone. Thank you, Helen.

Helen Osborne: Terrific. I just want to wrap this together within health literacy. That’s the work I did with you and a lot of your colleagues, is to really introduce health literacy, what it is, who it most affects and what we can be doing about that. Now you’re talking about this topic area, too.

From your perspective doing it all, how do you see those two linked?

Nicole Liebau: I think the big piece for anyone with healthcare fraud is making sure that people understand any of the information or outreach materials related to healthcare, because it’s complicated.

Helen Osborne: It sure is.

Nicole Liebau: It’s very complicated. I think it’s important, especially in working with older adults, which we do at the SMPs, to be able to provide that understanding and one-on-one assistance for those educational items.

Again, our program, we want to spread the word that prevention is really what we want. We want to prevent anything from happening. It’s knowing that people can understand that complicated information so we can prevent fraud from happening to people in the first place.

To your point at the beginning of the podcast, we really want to prevent medical identity theft and any type of potential patient harm that could happen due to fraud. Sometimes there are cases of direct patient harm, unfortunately, or benefit loss.

Helen Osborne: When I was talking with you and colleagues, I remember you were saying some people do this in written information. Sometimes you have group meetings or educational sessions. Sometimes you might be talking one-on-one, whether in person or over the phone. In all those situations, our words really matter, and to put it into context of a person’s life.

As you and I are talking right now, I’m remembering this spammy email I got last week. You’re talking about healthcare fraud, but I’m relating it to someone is trying to get my information they shouldn’t be getting.

Is that where health literacy comes in, putting it in context with their life, something that’s familiar, and then teaching them how to take the appropriate actions?

Nicole Liebau: Yes, it is. Again, whether it’s healthcare fraud or just getting your personal information, they change their tactics and approach. Again, it’s relaying that information so it’s not complicated.

We talked about red flags. That’s how we educate. Continually, fraud will always evolve. Scammers will always evolve.

I think with the health literacy piece, it’s so important we create resources for different people to be able to gain that information or know who to call.

Whether it’s a caregiver, a family, in rural areas or anyone, to be able to provide that information in the way that can best be used is just so important.

Again, without being informed, it’s really hard to prevent something like that unless people get that information and know what to look for, because something could look very legitimate.

Helen Osborne: It’s not inherent. Some people are just very trusting of others. You have to be talking about something that’s hard, difficult and ever-changing.

Nicole, hearing this and having worked with you a while, I am so grateful you are doing what you’re doing. Not just you, but the SMPs all over the country.

There are wise, smart people helping to educate the public about all these issues of potential fraud, healthcare fraud and healthcare abuse. I love the way you tie that together with health literacy and recognize that importance.

Nicole, thank you for all that you do and for sharing it with us on Health Literacy Out Loud.

Nicole Liebau: You’re welcome, Helen. I just want to say a few last things. I think anybody, if you see something, say something. It’s so important to our healthcare systems and the integrity of all of our programs to continue to have healthcare, especially people who may be more at risk.

Thank you to you, Helen. Thank you to everyone for listening.

Helen Osborne: You’re great. Thanks.

As we just heard from Nicole Liebau, it is important to pay attention to potential healthcare fraud and abuse. Tough topics to talk about. Doing so is not always easy.

For help clearly communicating your health message, take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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