This month, we’re highlighting our SMP Liaison, Carolina Oehler! She is the Program Specialist and HICAP Volunteer & Outreach Coordinator with the Health Insurance Counseling and Advocacy Program (HICAP) at Kern County Aging & Adult Services Department.
Carolina came to HICAP after working in the hospitality and tourism industry for 13 years in Florida. Having been born and raised in Bogota, Colombia, she moved to the United States in 1999 and lived in Orlando, Florida for 17 years before moving to California in 2016. She said her time in the private sector of the hospitality industry, “making happy memories for visitors,” really honed her skills and passion for connecting with people and making a difference in someone’s life. “Back then it was more about making happy memories and holidays for visitors, whereas now it’s about making lives easier for aging and disabled populations,” Carolina reflected. She loves the joy she sees and receives from people when “they feel connected and have peace of mind knowing that someone is advocating for them, helping them navigate the complex health care system and in fraud prevention.”
More on how Carolina came to HICAP & SMP
Carolina explained that her opportunity to join HICAP practically fell into her lap. She had recently been her mom’s advocate through two cancers, helping her with her doctor’s visits, referrals, paperwork, as well as researching issues and helping her ask the right questions. In addition to helping her mom, she was often the one people in her family would turn to to talk through health concerns and make a plan of action.
Through her experience with her mom and other relatives, she dove into educating herself in health care policy, patient rights, and advocacy. And then, in 2018, she found HICAP – the Health Insurance Counseling and Advocacy Program. She saw a job opening that would give her the opportunity to become a HICAP Counselor, she applied and was hired! Carolina was thrilled. Now she could use her passion and skills to help and advocate for so many more people. “I couldn’t believe I could be part of such an important program,” beamed Carolina.
After 3 years serving as a counselor, she was promoted to her current position of HICAP Volunteer & Outreach Coordinator. “Now I am able to reach to more individuals through outreach, presentations, free webinars, newsletters, ads, and I’m always thinking on what we are gonna do next to promote our HICAP services and of course the SMP message,” smiled Carolina.
Carolina started to have a deeper interest in the Senior Medicare Patrol (SMP) after going through her first Medicare Open Enrollment season as HICAP staff. Some of the clients she had assisted in doing health plan comparisons and choosing the best plan for them and their needs during fall Open Enrollment and came back early the next year. They complained of being switched out of their chosen health plans without their knowledge. They had fallen victim to Medicare enrollment fraud. This highlighted for Carolina how important it was for beneficiaries to know first that fraud exists in Medicare. They also need to know the current health care scams and the red flags to detect Medicare fraud. She realized just how important fraud prevention is.
As Carolina started doing more community presentations, she made sure to always include information on Medicare fraud prevention and an update on scams to watch for. She also brought a lot of cases to their former SMP liaison.
How Carolina became Kern County’s SMP Liaison
“It was bittersweet,” said Carolina. She became Kern County’s SMP Liaison in 2020, after SMP Liaison Leanne Morgan passed away in December 2019. Leanne had served the community as an advocate for over 20 years. She was a mentor and friend to Carolina and to many. “She led by example,” said Carolina. “She had a genuine desire to help everyone. She was a true advocate at heart, and would not ever give up until she saw a case resolved.”
Leanne taught Carolina to identify the red flags of fraud, how to trouble-shoot cases and about the importance of bringing awareness to the most vulnerable. Leanne Morgan helped many beneficiaries with very difficult cases, and Carolina felt she had very big shoes to fill. Yet all Leanne’s lessons and advice have stuck with her. Carolina shares that it “brings her joy to be her county’s SMP Liaison and continue that legacy.” She feels the responsibility too and will continue to do her very best.
A “super success” fraud case to share
In 2021, Carolina’s office received a call from a beneficiary’s daughter. Her mother had started receiving an alarming amount of bills for services normally covered by Medicare. “Why were they denied? Was there a mistake,” the daughter asked? The HICAP counselor working with the daughter found that her mother had been fraudulently enrolled in hospice. The counselor then referred the case to Carolina and she worked with our California SMP to restore her coverage and recover the monies to Medicare.
During the process, Carolina worked to gather the details from the daughter. Who did her mom talk to? Did she sign anything? Did anyone come to her house? She got a copy of all the denied bills and found 13 claims denied. She called the beneficiary’s providers to request a temporary hold on the bills as they worked out the issue with Medicare, and contacted Medicare directly to report the beneficiary’s compromised number. Medicare issued her a new number and card. Our CA SMP followed up with the Centers for Medicare and Medicaid Services (CMS) and found the hospice agency had billed Medicare and was paid over $12,000! Carolina said both CA SMP and CMS were very diligent in following up on the case and got the Office of Inspector General involved in the investigation.
Overall, the case turned out to be a “super success” story, with all the monies recouped, provider claims paid and the beneficiary’s Medicare coverage restored. It was a great team effort with the HICAP Counselor, Carolina as the SMP Liaison, our California SMP staff and CMS. “In the end,” Carolina said, “both mom and daughter were so thankful both for the good news and for our services.”
What Carolina enjoys most about being an SMP Liaison
Carolina loves the opportunity to give direct, immediate help and see tangible results. “It’s such an accessible program,” said Carolina. “We’re not a call center in another state or country. We’re here locally and people can see and interact with us – at a senior center, an outreach event or in our office. We’re here to provide real and immediate help.”
She also loves the success stories. “There’s nothing more rewarding than solving someone’s problem. If not for our collective efforts, most clients would have a very hard time solving these complex Medicare fraud and coverage issues themselves,” she reflected.
Outreach and education are also a highlight of her work. She enjoys seeing surprised looks on people’s faces during presentations. “When I tell people to guard your Medicare card as a credit card, jaws drop. Often people don’t realize how important their Medicare number is,” Carolina said.
In addition, Carolina enjoys staying up-to-date on state and federal legislation. For example, the Inflation Reduction Act passed last summer. This was great news for so many people. With Medicare legislation and coverage always changing, she’s always learning.
Carolina is fluent in Spanish and also enjoys the bilingual and bicultural work she does both with clients and in coaching other Spanish-speaking volunteers. It can be hard to explain scams and the intricacies and concepts of Medicare in a way that native Spanish-speakers understand and that is not so official. She likes being that linguistic and cultural bridge for people and training others to do the same.
Additional information & interests of Carolina
Often referred to as “Caro” by family and friends, she loves traveling to places like Hawaii, Florida, Mexico, and thoroughout her new home of California as much as she can. She’s going to Europe in September to visit London, Paris and Rome and loves planning such adventures and learning the cultures and languages from where she visits. Her husband is an adjunct history professor so also shares this big love of travel and culture.
In addition to such travel, Carolina enjoys yoga, spending time with her husband and her dog, Kona and cat, Gustavo. She loves cooking and crafting cocktails and is an avid Miami Dolphins and Dodgers fan.
Carolina describes herself as self-driven, motivated, honest, passionate, and kind. She loves to promote kindness and make people feel important and appreciated. She’s very involved in charity and in 2014 started a fundraising effort benefiting Children’s Hospital of Orange County (CHOC) that’s still going strong today. They’ve raised over $30,000 for CHOC! She also makes gemstone bracelets and donates the money to conservation efforts protecting sea turtles.
Final tips from Carolina on Medicare fraud prevention
- Treat your Medicare card as if it is your credit card. Only give that number to your provider(s) and people you trust.
- Look at the small print on mail you receive. Not everything that looks official is official. Read the disclaimer; many of them state that it is a solicitation for insurance from an LLC or insurance broker, not Medicare.
- You are the one to initiate contact with providers and insurance agents – not the other way around.
- Nothing is for free. If it looks too good to be true, it probably is.
Thank you for the gem of a person that you are, Carolina! And thank you for all you do, on behalf of HICAP and SMP and many. You truly make our world a better place!