A dissertation completed at
The Center for Education, Widener University,
One University Place, Chester, PA 19013 		 
AN EVALUATION OF THE HEALTH CARE FRAUD EDUCATION PROJECT
Earl Goldberg, Ed. D.
March 22, 2001

RETURN
edited 5/16/01

 


ABSTRACT

Our society has experienced rapid growth in the older adult population as medical science has progressed through the twentieth century. In 1995, the federal government initiated Operation Restore Trust to combat fraud in the Medicare and Medicaid programs. Funding was increased in1997 with the passing of the Balanced Budget Act. Areas of concentration were home health care, durable medical equipment and nursing homes. The federal government soon initiated grants toagencies that would educate senior citizens about how to prevent health care fraud.

This was the first program initiated to fight the problems associated with financial exploitation of the elderly. Senior citizens, many living alone, are vulnerable to many different kinds of exploitation and abuse. Some examples of problems this program attempts to combat are overcharging for medical equipment and inadequately provided home-health care. However, the most serious of these problems is criminal neglect of patients in nursing homes. Long-term care facilities have billed the government for the care of institutionalized elderly, while providing inadequate services. Recently, this kind of elder abuse has been criminally prosecuted in many states, leading to convictions, fines and changes in ownership of nursing homes. Additionally, Operation Restore Trust funded programs have recovered millions of dollars in misused funds.

The Coalition for Advocacy for the Rights and Interests of the Elderly (CARIE), based in Philadelphia, applied for and received a grant from the Administration on Aging. CARIE has run the Healthcare Fraud Education Project for three years and has trained over fifty senior volunteers to speak to senior citizen organizations about preventing Medicare Fraud. Recently this grant was renewed for another three-year period. CAR1E already ran a successful abuse prevention hotline and a volunteer nursing home ombudsman program. Many of the senior citizen volunteers work in more than one of CARIE's programs.

Little research has been published in the areas of Medicare fraud or senior volunteer educational projects. The questions of how well seniors learn new concepts and which practices are best have not been explored in this environment. However, this study draws on previous principles of adult education to serve as a foundation for the training concepts. Additionally, older adults have special learning needs, such as pacing and sensory compensation. An in-depth evaluation was needed to explore the experiences of the participants of this project.

This researcher spent time in the field to assess the milieu by attending training functions and analyzing project documents. After a rapport was developed, administrators and the most experienced volunteer educators were interviewed. Using grounded theory methodology, themes were developed from inter-views, documents and vignettes to enhance understanding of the educational processes and experiences of this project.

Observation of training sessions and the experiences of the participants provided data which supported a positive evaluation of the project. Recognition and empowerment of the volunteers lead to a positive educational environment. CARIE used sensory compensation and multiple mode presentation in their training practices. However, not enough attention was paid by the project to hearing deficiencies in the elderly. A convergence of activity and continuity theories best describes the development of its volunteers. Best practices for older adult education were recommended and suggestions for future research were provided.

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