Medicare provides essential health coverage to millions of older adults and people with disabilities—but unfortunately, it’s also a frequent target for fraud and scams. Each year, billions of dollars are lost to fraudulent claims, deceptive phone calls, and identity theft schemes that not only cost the government money but also put your personal information and healthcare benefits at risk.
Scammers often target Medicare beneficiaries because they assume older adults are more trusting or may be unfamiliar with how Medicare works. These bad actors might pose as Medicare representatives, insurance agents, or even doctors’ offices to trick you into giving out your Medicare number, Social Security number, or other sensitive information. Once they have this data, they can use it to bill Medicare for services or equipment you never received—or worse, steal your identity.
The good news is that by staying informed and alert, you can protect yourself. Medicare fraud isn’t just about financial loss—it can also delay or interfere with your legitimate medical care. Whether you’re a new Medicare enrollee or have had coverage for years, learning how to recognize the warning signs and knowing what steps to take can make a big difference.
In this article, we’ll show you:
- The most common types of Medicare fraud and scams
- Warning signs to watch out for
- Simple steps to protect your Medicare information
- What to do if you suspect fraud or become a victim
With the right precautions, you can keep your information safe and help prevent Medicare fraud for yourself and others. Let’s look at how to stay one step ahead.
The Most Common Types of Medicare Fraud and Scams
Medicare fraud and scams come in many forms, and fraudsters are constantly evolving their tactics. Some schemes are subtle, while others are more aggressive. Being aware of the most common types of Medicare fraud can help you recognize a scam before it becomes a problem.
1. Billing Fraud
This is one of the most common types of Medicare fraud. Healthcare providers or suppliers bill Medicare for:
- Services or equipment that were never provided
- More expensive services than were actually given (called upcoding)
- Unnecessary services
- Duplicate claims for the same service
In many cases, beneficiaries are unaware this is happening unless they closely review their Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).
2. Medical Identity Theft
Scammers may steal your Medicare number or Social Security number and use it to:
- File false claims under your name
- Obtain medical equipment or services fraudulently
- Sell your information to other criminals
This can lead to errors in your medical records or even interfere with your legitimate care.
3. Fake Medicare Representative Calls
Scammers may call you claiming to be from Medicare or a “Medicare office” and ask for personal details to issue a new card, confirm coverage, or offer a service. Medicare will never call you uninvited to ask for private information.
4. Free Gifts or Services
If someone offers you free medical supplies, COVID-19 test kits, genetic testing, or other items in exchange for your Medicare number, it’s likely a scam. These “free” items often result in fraudulent billing, and you may receive a surprise charge later.
5. Telehealth Scams
Since the rise of telehealth, some scammers pose as telemedicine providers to get your Medicare number. They may conduct a fake consultation or offer unnecessary tests, then bill Medicare.
Warning Signs to Watch Out For
Spotting Medicare fraud early can help you avoid financial and health complications. Here are some common red flags:
1. You’re Asked for Your Medicare Number by Phone or Email
Medicare will never call or email you out of the blue to request your number or personal information. If someone does, it’s likely a scam.
2. You See Charges for Services You Didn’t Receive
Regularly check your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for unfamiliar services, charges, or providers. These could indicate fraudulent billing.
3. You Receive Unsolicited Medical Equipment
If you receive a brace, walker, or other device that you didn’t request—and then see a charge for it—it may be part of a scam. Do not accept packages you didn’t order.
4. Someone Offers You a Free Gift in Exchange for Your Medicare Number
No legitimate provider or company will offer free services or products in exchange for your Medicare information.
5. Pressure to Make Quick Decisions
Scammers often use urgency or fear tactics to pressure you into giving information or enrolling in a plan immediately. Always take time to verify any offer.
6. You’re Contacted About a “New” Medicare Card
Medicare is no longer issuing new plastic cards or updated cards based on new programs. Anyone claiming this is likely running a scam.
Simple Steps to Protect Your Medicare Information
Protecting your Medicare information is key to avoiding fraud. Just like you guard your credit card or banking details, your Medicare number should be treated with the same level of care.
1. Protect Your Medicare Card
- Keep it in a safe place, just like your driver’s license or credit card.
- Do not carry it with you unless you’re going to a medical appointment.
- Never show it to anyone who doesn’t need it for medical billing or treatment.
2. Guard Your Medicare Number
- Only give your Medicare number to trusted healthcare providers or verified Medicare agents.
- Never give your number over the phone unless you initiated the call and verified the recipient.
3. Review Your Medicare Summary Notices (MSNs)
- MSNs list all services and supplies billed to Medicare in your name.
- Review these notices when they arrive to check for anything suspicious.
- If something doesn’t look right, write it down, and call Medicare or your provider for clarification.
4. Create a MyMedicare Account
- By signing up at Medicare.gov, you can monitor your claims in real time.
- This is often faster than waiting for mailed MSNs and gives you an early look at any unusual billing.
5. Be Cautious of Marketing Calls
- Medicare does not allow unsolicited marketing calls from insurance agents or providers.
- If someone calls trying to enroll you in a Medicare plan or asking for your number, hang up.
6. Shred Documents with Personal Information
- Never throw away MSNs, insurance paperwork, or documents with your Medicare number without shredding them first.
7. Enroll in Identity Protection Services
- Some credit monitoring and identity theft protection plans now include medical ID monitoring.
- These services can help alert you if your information is used to file false claims.
What to Do if You Suspect Fraud or Become a Victim
Even if you’re careful, it’s still possible to become a target of Medicare fraud. Acting quickly can limit the damage and protect others.
1. Contact Medicare
If you suspect that your Medicare number has been misused or you spot unusual charges:
- Call Medicare at 1-800-MEDICARE (1-800-633-4227).
- You can also report suspected fraud online at medicare.gov.
Provide as much detail as possible, including:
- Dates of services
- Charges in question
- Provider names
- A description of what you believe is fraudulent
2. Contact the Office of the Inspector General (OIG)
You can report Medicare fraud to the OIG hotline:
- Call 1-800-HHS-TIPS (1-800-447-8477)
- Or file a report online at oig.hhs.gov
You can choose to remain anonymous when reporting fraud.
3. Inform Your Provider
Sometimes billing errors are just that—errors. If you spot something odd on your MSN, call the provider first to confirm whether it was a mistake before escalating the issue.
4. File a Police Report (If Identity Theft Occurred)
If your Medicare number was stolen and used in a scam, contact your local police department and file a report. This may be needed for resolving identity theft claims.
5. Place a Fraud Alert
If your Social Security number was also involved, consider placing a fraud alert or credit freeze with one of the major credit bureaus (Equifax, Experian, or TransUnion).
6. Contact Your State Senior Medicare Patrol (SMP)
SMPs help Medicare beneficiaries prevent, detect, and report fraud. They offer free counseling and assistance if you’re unsure how to proceed.
Visit smpresource.org to find your local SMP.
Being informed and vigilant is your best defense against Medicare fraud. Knowing the most common schemes, understanding the warning signs, and taking proactive steps to guard your information can help keep your coverage safe and prevent scammers from taking advantage of you or your benefits.
Conclusion: Stay Informed and Stay Protected
Medicare fraud and scams can happen to anyone—but with knowledge and vigilance, you can greatly reduce your risk. Scammers rely on confusion, trust, and quick decisions to gain access to your personal information and benefits. By staying alert to the warning signs—like unsolicited calls asking for your Medicare number or suspicious charges on your Medicare Summary Notice—you can stop fraud before it affects your coverage or identity.
It’s also important to remember that protecting your Medicare information is just as important as protecting your bank account or credit card. Keep your Medicare card secure, avoid sharing your number unless absolutely necessary, and review all claims and billing notices carefully. If anything seems out of place, don’t hesitate to contact Medicare, your provider, or the Office of Inspector General.
Taking action doesn’t just protect you—it helps reduce fraud across the entire Medicare system, preserving funds for those who truly need care. Reporting fraud also plays a role in holding dishonest providers and criminals accountable, preventing future scams.
Finally, you’re not alone in this. Organizations like your State Health Insurance Assistance Program (SHIP) and Senior Medicare Patrol (SMP) are available to provide free, unbiased help. Whether you need assistance reviewing bills, identifying fraud, or taking next steps, help is just a phone call away.
With a little awareness and caution, you can navigate Medicare safely and confidently—keeping your health, identity, and finances secure.
