This month, we’re highlighting our California Senior Medicare Patrol (SMP) partner, Beatriz Garcia!
Beatriz works at CRLA (California Rural Legal Assistance), a nonprofit law firm serving low-income residents all over the state of California, and has worked there for 14 years. During this time, she has gained a lot of experience dealing with all sorts of fraud and abuse, which has been especially pertinent in our partnership.
Beatriz’s relationship with SMP started when our former SMP Director, Micki Nozaki, reached out to CRLA to see if they were interested in partnering with SMP and doing outreach. This was a good fit because CRLA had already started seeing a lot of Medicare fraud cases, and SMP was able to fill in the gaps and provide information and assistance to them and their clients.
Over the years, Beatriz has been able to work with many different types of Medicare fraud. Here are two cases that may highlight a familiar type of Medicare fraud you know about, or something new that you didn’t know was fraud!
Case 1
In one case, an elderly man called Beatriz at CRLA because he went to the pharmacy and couldn’t get his flu shot and test strips for his diabetes. He had both Medicare and Medi-Cal and couldn’t understand why he was denied these services. When he asked, the pharmacist had told him that he was enrolled in hospice and had to pay out of pocket for both things unless a hospice doctor ordered it.
Upon hearing this from her client, Beatriz realized this was likely hospice fraud. She called Medicare to report it and got her client disenrolled from hospice and back on his regular Medicare benefits. The next day, this elderly man was able to go back from the pharmacy and get both his flu shot and diabetic test strips. Beatriz also reported this case to our CA SMP, as fraudulent hospice enrollments are still one of the top scams we are seeing.
Case 2
In another case, a beneficiary contacted Beatriz at CRLA because of a medical bill she received for radiology services. Her granddaughter had called to inquire about it, and was told that it was denied because the beneficiary was enrolled in hospice.
Again suspecting hospice fraud, Beatriz called Medicare with the client present, and confirmed that yes indeed, the client was enrolled in hospice. As Medicare only covers palliative care when on hospice and no curative treatments, Medicare denied payment for the radiology service.
Beatiz then referred the case to SMP and requested Medicare Summary Notices (MSNs) for the past year and a half, as well as a new Medicare card for the beneficiary. After receiving the MSNs, Beatriz saw that the beneficiary had been on and off of hospice enrollment for the last year and a half – something that is not common. The total bill came to over $40,000 in hospice charges from December 2020-March 2021, including bills for several thousand dollars for skilled nursing visits, which the client had not received.
Our California SMP is helping this client resolve the bills with Medicare so the provider can get reimbursed. The beneficiary doesn’t know how the hospice agency got her information. She lives in a senior home that often has presentations, but she has never given out her Medicare card.
What Beatriz likes most about what she does…
Beatriz’s favorite part of her job is educating not only clients, but also her clients’ families. Clients end up referring their friends and family to CRLA, so she has the opportunity to educate more and more people, and loves this. Through cases, Beatriz is able to find out about larger issues to help the individual, as well as tackle issues to make a larger scale change. She is also able to help with client eligibility for benefits, and wants each person to have as many resources as possible, as well as access to healthcare.
Tips for those on Medicare
Beatriz’ tips for those on Medicare and/or with loved ones on Medicare: Always keep your Medicare card safe (only show to medical providers)! Especially during the pandemic, there are people taking advantage of seniors by offering “new” Medicare benefits.
Here is the website of the statewide collaborative that CRLA partners with: https://healthconsumer.org This is a great resource for health consumers and advocates!
More on Beatriz
Beatriz is a daily coffee drinker, and her favorite is Starbucks Christmas blend! She is an aunt to a 10 year old and loves kids. One of her favorite hobbies is traveling. Some of her favorite places she’s been includes Tahiti, Hawaii and Italy. She loves trying the food and seeing the differences from American food (including fresh pasta, seafood, and fresh fruit).
Thank you for the amazing work you do, Beatriz! We are proud to have you as one of our SMP partners.
