Korean Officials Meet with CA SMP to Learn How We Fight Fraud

Korean Officials Meet with CA SMP to Learn How We Fight Fraud

Last fall our California Senior Medicare Patrol (SMP) had a visit from several Korean officials. They were from the Institutional Improvement Division of the Anti-Corruption and Civil Rights Commission (ACRC), a division dedicated to fighting corruption and fraud in Korea. Why did they visit, you may ask? These officials were on a mission to stop the corruption found in their entitlement and social welfare programs and to ensure transparency and integrity in their public health care system. Throughout 2012, they visited various overseas governments, NGOs and academic institutions as a way to study the ideas, experiences and practices/systems used to combat fraud. Upon seeing a press release from the U.S. Department of Health and Human Services that mentioned the Senior Medicare Patrol, these Korean officials became interested in SMP’s activities and accomplishments in preventing and detecting health care fraud, waste and abuse.

Therefore, in early December, a group of 3 Korean officials came to our Santa Ana SMP office to meet with our SMP Project Director, Julie Schoen, SMP Project Coordinator, Anne Gray and our Data Specialist, Micki Nozaki. They wanted to learn firsthand how our health care system works, where we see fraud, the kinds of fraud we see and what we’re doing to prevent and detect it. The delegation was surprised to learn how openly we broadcast fraud, letting the public know of the problem as a way to help prevent, detect and report it. In Korea, they don’t publically advertise the problem, even though it is a major issue there. Also, although it was a challenge to explain our complicated Medicare program, the layers of coordination, government oversight and flow of funds through translators, these officials were nonetheless enthusiastic to learn and took copious notes. Our SMP shared stories of “capper schemes” and durable medical equipment fraud and they too expressed experiencing similar problems, especially with upcoding. For example, they have many cases of people being prescribed high-end wheel chairs when in reality they only receive basic ones.

One interesting cultural difference is the concept of volunteerism. The delegation wanted to understand why citizens would volunteer without pay to help SMP provide outreach and education and assist in reporting cases. They did not see the purpose in this, but when SMP explained that it was to preserve the integrity of the Medicare benefit and to keep the benefits intact for future generations, they responded positively and affirmed through the translator that they understood this passion to serve.

Having these Korean officials come learn from our SMP project was a delightful surprise, an honor and an enriching experience for everyone. These officials had an impressive thirst for knowledge and commitment to learn and improve the integrity of their own public health care system. In parting, they said they would follow up with our program in the future. CHA looks forward to seeing how their visit with SMP, as well as the Office of Inspector General and the Department of Health and Human Services will shape their health care delivery and fraud prevention system.

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Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.