Medicare Fraud: How to Protect Yourself and Report Scams

Medicare fraud costs billions of dollars annually and can put your health and finances at risk. Learning to recognize and avoid Medicare scams is essential for every beneficiary.

!A phone with a warning, representing protection against Medicare fraud and scams

What Is Medicare Fraud?

> About 54% of beneficiaries are in Medicare Advantage — and scammers frequently impersonate plans and 'Medicare' during enrollment season, so verify every caller. (Source: CMS / KFF, 2024.)

Medicare fraud occurs when someone intentionally deceives Medicare for personal gain. This includes:

• Billing fraud: Providers billing for services not provided
• Identity theft: Using your Medicare number for fake claims
• Kickbacks: Receiving payment for referrals
• Scams: Tricking beneficiaries into sharing personal information

Florida unfortunately ranks among the top states for Medicare fraud due to its large senior population.

Common Medicare Scams to Watch For

1. Medicare Card Scams

Scammers call claiming you need a new Medicare card or that your current card is being "upgraded." They ask for your Medicare number, Social Security number, or bank information.

The Truth: Medicare will never call you unsolicited to verify your number or ask for payment for a new card.

2. Free Medical Equipment Offers

Calls or ads offering free medical equipment (back braces, knee braces, wheelchairs) in exchange for your Medicare number.

The Truth: Medicare only covers medically necessary equipment ordered by your doctor.

3. Health Fair Scams

Booths at health fairs offering free services or screenings while collecting Medicare numbers for fraudulent billing.

The Truth: Legitimate screenings don't require your Medicare number on the spot.

4. Open Enrollment Scams

During enrollment periods, scammers pose as Medicare representatives offering to help you "review" your coverage or warning about plan cancellations.

The Truth: Medicare doesn't call to sell you plans. Licensed agents must identify themselves and their company.

5. COVID-19 and New Benefit Scams

Offers for free COVID tests, new Medicare benefits, or stimulus payments in exchange for personal information.

The Truth: Verify new benefits through Medicare.gov or 1-800-MEDICARE.

6. Genetic Testing Scams

Unsolicited offers for free genetic or DNA testing, sometimes door-to-door or at events.

The Truth: Genetic tests must be ordered by your doctor when medically necessary.

How to Protect Yourself

Guard Your Medicare Number

• Treat your Medicare number like a credit card number
• Only share it with trusted healthcare providers
• Don't give it out over the phone to unsolicited callers
• Never share it in response to emails or texts

Review Your Medicare Summary Notices

Every three months, review your Medicare Summary Notice (MSN) for:

• Services you didn't receive
• Providers you didn't see
• Equipment you didn't order
• Dates when you weren't at the provider

Be Skeptical of Unsolicited Contact

• Medicare won't call to sell you something
• Medicare won't threaten to cancel your coverage
• Medicare won't ask for payment over the phone
• Legitimate agents identify themselves and don't pressure you

Verify Before You Trust

• Ask for written information
• Verify callers' identities independently
• Check credentials at Medicare.gov
• When in doubt, hang up and call Medicare directly

How to Report Medicare Fraud

If You Suspect Fraud

Call 1-800-MEDICARE (1-800-633-4227)

• TTY: 1-877-486-2048
• Available 24/7

Report to the HHS Office of Inspector General

• Online: oig.hhs.gov/fraud/report-fraud
• Phone: 1-800-HHS-TIPS (1-800-447-8477)

Contact Your State's Senior Medicare Patrol (SMP)

• Find yours at smpresource.org
• Free assistance for Medicare beneficiaries

What to Report

• Provider names and addresses
• Dates of service
• Items or services billed incorrectly
• How you discovered the problem
• Your Medicare Summary Notice

Whistleblower Rewards

Under the False Claims Act, you may be entitled to a portion of funds recovered from fraud—sometimes millions of dollars for major fraud cases.

Signs a Provider May Be Committing Fraud

Watch for providers who:

• Bill for services not received
• Bill for more expensive services than provided (upcoding)
• Perform unnecessary tests or procedures
• Waive copayments without financial hardship documentation
• Offer kickbacks for referrals
• Pressure you to agree to services

What Happens If You're a Victim

If your Medicare number is stolen:

1. Report it immediately to 1-800-MEDICARE 2. Request a new Medicare number (you can get one) 3. Review all MSN statements carefully 4. Monitor your credit report for healthcare-related fraud 5. Document everything for investigations

Working with Legitimate Medicare Advisors

To avoid scams while getting help with Medicare:

• Verify licenses at your state insurance department
• Meet in person when possible
• Never feel pressured to make immediate decisions
• Get everything in writing
• Know that real advisors don't ask for payment

A licensed, ethical Medicare advisor provides free guidance without pressure tactics or requests for sensitive information upfront.

Next steps: Take our 2-minute Medicare plan quiz, book a free Medicare review, or see our Medicare costs guide.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.