How to Spot and Avoid Medicare Scams

Preventing Identity Theft and Medicare Fraud

In This Article

Healthcare fraud is more common than you realize. In fiscal year 2019 alone, the federal government recovered $2.6 billion in healthcare fraud and false claims. Keep in mind that number only reflects the cases that were actually caught. Odds are there was more loss that went undetected.

Senior citizens are subjected to Medicare scams all the time. Someone could defraud Medicare with your information or use your information to get treatment for themselves.

If you have a Medicare Advantage plan that has an annual cap on services, that could mean you are forced to pay more out of pocket. Medical supplies or medications they get using your Medicare ID could be sold for profit.

Scammers could even sell your personal information on the dark web and try to access your financial records. It is important to recognize these scams when they happen and to report them to prevent this kind of abuse.

Senior woman wearing glasses using laptop at home
10'000 Hours / Getty Images

Billing Scams

Unfortunately, there are some medical professionals out there who will bill Medicare for services or medical equipment that were never provided. Scammers can also impersonate a medical office or healthcare provider and send you a fake bill. They literally bank on the fact that you will pay any bill you receive without verifying it against other information.

Watch out For

  • Bills from hospitals you did not visit
  • Bills from providers you do not know
  • Bills for services you did not receive

It is important that you track your Medicare use. If you are on Original Medicare (Part A and B), you will get a Medicare Summary Notice (MSN) quarterly. If you are on a Medicare Advantage plan (Part C), you will receive an Explanation of Benefits (EOB) monthly.

These documents are not bills. They will list important information about any Medicare services you received during those time frames. Specifically, they will list out what Medicare paid toward your care and how much you are left to pay out of pocket. Any discrepancies between a bill you receive in the mail and your MSN or EOB could be a scam.

In-Person Scams

Be suspicious of anyone who comes to your home claiming to be from Medicare. They may try to sell you a product or entice you with "free" services. This is an attempt to gather personal information. Medicare does not send representatives to your home for this purpose. Do not open the door.

Any Medicare-approved services that are provided in the home will be scheduled in advance. Whether it is nursing care, physical therapy services, or a physician performing an Annual Wellness Visit for a Medicare Advantage plan, these healthcare professionals should never ask you for financial information.

Phone Scams

Medicare is not going to call you unsolicited. If for some reason more information is needed to process your Medicare application, the Social Security Administration will first reach out to you with an official letter to schedule a phone interview.

Otherwise, the only calls you can expect to receive from Medicare are those that you request yourself, either by written letter or by calling Medicare directly at 1-800-MEDICARE (1-800-633-4227).

Although a formal Medicare call may require you to share some identifying information (again, these calls are far and few between), they will never ask you for your credit card number or banking information.

Scammers will often try to extract that information from you and will try to get you to provide your Social Security and Medicare numbers as well. Don't fall for it.

Watch out For

  • Calls that ask you to confirm you received your Medicare card, to "activate" your Medicare card, or to "renew" your Medicare card
  • Calls that claim Medicare owes you a refund
  • Calls that offer free services or medical supplies (e.g., back and/or knee braces, COVID-19 screening tests and treatments, genetic testing for cancer)
  • Calls that solicit you to sign up for new Medicare plans or to update your current plan
  • Calls that threaten to cancel your Medicare coverage unless you update your information

For the record, you never need to activate or renew your Medicare card, there are no approved treatments for COVID-19, and Medicare rarely covers genetic testing. Also, some medical supply companies may offer "high-quality" products like braces but go on to deliver inexpensive low-quality versions. They pocket the cost difference.

To protect yourself, verify the source of any calls you receive. It is best to tell the caller you will call Medicare or your health plan directly to address whatever issue they are raising. Hang up!

Marketing Scams

Medical Open Enrollment season runs from October 15 to December 7. During this time, seniors are inundated with mail about different Medicare plans. Some of that information may be valid, others may represent false advertising. It is important to separate fact from fiction.

Watch out For

  • Claims that you can change your plan at any time
  • Claims that a plan will save you on Part B premiums
  • Claims that you have to sign up for a Medicare Advantage plan to get prescription drug coverage
  • Claims that you will get "extra" services even though they are already covered by Medicare
  • Claims that you will lose Medicaid coverage unless you sign up for their plan
  • Claims that a representative must come to your home to finalize your plan

To be clear, you can only change Medicare plans during certain enrollment periods. Part B premiums are fixed based on your income. Unless you qualify for a Medicare Savings Plan through Medicare, your Part B premium will not be decreased. While Medicare Advantage plans can include prescription drug coverage, you can also sign up for a Part D plan with Original Medicare.

If you are new to Medicare, your best bet is to go to the Medicare Plan Finder to make sure you are getting accurate information. This official government site lists details about all the approved Medicare plans. You can enroll through the site as well.

If it makes you more comfortable to speak with an insurance agent, be sure to find one that is certified. You can verify their credentials through the National Association of Insurance Commissioners to assure they are legitimate. Do not give information to anyone who calls you unsolicited.

How to Report a Medicare Scam

If you believe you have been approached with a Medicare scam, you should report the incident as soon as possible. It is important to hold people accountable and to prevent others from being subjected to the same scams.

Reach out to Medicare at 1-800-MEDICARE (1-800-633-4227) or the Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477).

If you believe your personal information has been compromised, you can also reach out to the Federal Trade Commission (FTC) at 1-877-FTC-HELP (1-877-382-4357).

A Word From Verywell

Healthcare fraud, including Medicare scams, cost the United States billions of dollars every year. Don't be a victim. Protect yourself by reporting Medicare scams when you see them.

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Article Sources
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  1. Justice Department Recovers over $3 Billion from False Claims Act Cases in Fiscal Year 2019. U.S. Department of Justice. January 9, 2020.