Medicare Fraud: Warning Signs and How to Avoid Being Scammed

Medicare FraudMedicare fraud is on the rise and while many may feel immune to the risk of scams, each year, senior citizens lose around $37 billion to fraud, and a large portion of that comes from healthcare scams.

Thankfully, there are ways to keep yourself safe in situations of Medicare fraud. It’s imperative for seniors and caregivers to be conscious of potential warning signs, proactive in prevention, and aware of what to do in a healthcare scam situation.

Warning Signs

There are several indicators of Medicare fraud you should be suspicious of if identified. Generally, scammers will personally call or use robocalls to communicate with those they intend to mislead. Phone scams often include an offer of free medical services, consultations, or supplies in exchange for your Medicare card number. They may also call pretending to work for Medicare and warn that you may lose your Medicare coverage if your information is not given. Medicare employees will never call you without you calling them first and you should never give your Medicare number out over the phone to anyone who calls unsolicited.

Other warning signs may appear on your Medicare Summary Notices (MSNs). MSNs are statements from Medicare that list recent claims made by healthcare providers. If you ever receive an MSN or bill from a hospital or medical provider for care that you did not receive, it is most likely a case of Medicare fraud. Fraud may also come in the form of being charged for services you are told you would receive but never do. Rule out error first by calling your plan provider and asking for an explanation.

Recently, fabricated-charge fraud has occurred in the form of unplanned genetic testing amongst seniors. Medicare policyholders will provide their information to undergo what is referred to as “genetic testing” or “DNA testing.” These tests are intended to reveal if patients have a genetic disposition to certain diseases, but results are often never provided despite the provider filing a claim using your Medicare information. While the Medicare beneficiary usually pays nothing, their personal information is compromised.

Scam Prevention

The first step in prevention is staying mindful of the warning signs and validate all suspicious calls and offers. This is especially important during annual enrollment periods (AEPs), a prime time for scammers to attempt to scam older consumers into providing unnecessary enrollment information and purchasing inadequate policies. You should also make sure you only share your Medicare number and card with healthcare providers and insurance agents you trust.

Another preventative measure you can take is to write down the dates of all your healthcare-related appointments. This will ensure you can quickly identify if a claim is made for a service you did not receive.

Be sure to always destroy any old Medicare cards you have, paying special attention to ridding the card of your social security number. One other, and perhaps the most important way, to prevent Medicare scams is by staying educated. Always be aware of the medication you should receive at the pharmacy, know your rights when it comes to Medicare, stay up to date on what a provider can and cannot bill to Medicare, and be able to ask questions if an unusual interaction occurs.

In the Case of a Scam

Anyone can become the victim of fraud so it’s very important to safeguard your personal information. If you do find yourself in the middle of what you think may be a Medicare scam, contact 1-800-MEDICARE immediately.

In order to report fraud, you will need the following: the provider’s name, the service item you are questioning, the date the service or item was given or delivered, the payment amount approved by Medicare, the date on your MSN, your name(s) and Medicare Number, the reason you believe Medicare should not have paid, and any other information you have showing why Medicare should not have paid for a service or item.

Our Medicare advisors are happy to assist our clients who believe they have been scammed. You may contact us for more information and assistance here.


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