Medicare Fraud: How to Protect Yourself and Report It
Medicare fraud costs the United States an estimated $60 billion or more per year: money taken from a program that millions of older Americans depend on.
Worse, the people committing fraud often target Medicare beneficiaries directly. Scammers pose as doctors, insurance agents, government officials, and Medicare representatives. They steal your Medicare number, bill for services you never received, and sell you fake coverage.
If you are new to the program, our guide on basic Medicare facts can help you understand how Medicare normally works, which makes it much easier to spot when something looks wrong. Knowing how Medicare fraud works, and how to protect yourself, is an essential part of being a smart Medicare beneficiary.
What Is Medicare Fraud?
Medicare fraud occurs when someone knowingly and willfully submits false information to Medicare to receive payment they are not entitled to. It is a federal crime that carries serious penalties, including fines and prison time.
Fraud is distinct from billing errors, which happen accidentally. Fraud is intentional deception.
Common forms of Medicare fraud include:
Billing for services never provided. A provider submits a Claim for a doctor visit, test, or procedure that never actually happened.
Upcoding. A provider bills for a more expensive service than what was actually performed.
Identity theft using your Medicare number. A scammer obtains your Medicare information and uses it to bill Medicare fraudulently in your name.
Kickbacks. Illegal payments made to doctors or patients in exchange for referrals or for ordering unnecessary tests and equipment.
Phantom billing. Charging for services or equipment that does not exist.
Unnecessary services. Billing Medicare for tests or treatments that are not Medically necessary. These claims are typically billed under Medicare Part B, which covers outpatient services, so reviewing your Part B claims closely is one of the best ways to catch this type of fraud.
Common Medicare Scams Targeting Beneficiaries
Fraud does not always happen in a doctor’s office or billing department. Many scams target beneficiaries directly: over the phone, through the mail, online, and even at senior centers or community events.
The Free Equipment or Services Scam
Someone contacts you offering free medical equipment, such as a back brace, knee brace, diabetic supplies, or a glucose monitor, as long as you provide your Medicare number. In exchange, they submit inflated claims to Medicare in your name. You may never receive the item, or you receive something you do not need.
Warning signs: Unsolicited offers of “free” equipment, pressure to provide your Medicare number, no mention of a prescription or doctor’s order.
The Medicare Card Replacement Scam
A caller claims your Medicare card has been compromised or is being reissued and asks you to verify your Medicare number, Social Security number, or bank account.
Medicare does not call you to verify your card or number. If you did not initiate a call, hang up.
The Fake Insurance Agent
An individual posing as a Medicare insurance agent contacts you about a “new plan” or “better coverage.” They collect your personal information, Medicare number, or payment, and either disappear or use your information fraudulently.
Real licensed Medicare agents will provide their license number upon request and do not pressure you to decide on the spot. If you want to compare real Medicare Supplement options at your own pace, our tool to compare Medicare Supplement insurance rates lets you do that without giving your information to a stranger who calls you out of the blue.
The Fake Government Official
A caller claims to be from Medicare, CMS, the Social Security Administration, or another government agency. They may say there is a problem with your account, that you owe money, or that you need to update your information immediately.
Real Medicare and Social Security employees do not call you unexpectedly and ask for personal information or payment. If you are unsure, hang up and call the official number directly.
Health Fair and Community Event Scams
Some scammers set up booths at health fairs, senior centers, or community events and offer free screenings. They use the event to collect Medicare numbers and personal information, then submit fraudulent claims.
Your Medicare number is as sensitive as your Social Security number or bank account number. Guard it.
Telemarketing Drug Plan Scams
You receive a call about a “new” Medicare drug plan that offers lower costs. The caller asks for your Medicare number to enroll you. Once they have your number, they use it to submit fraudulent claims.
Medicare drug plan enrollment happens through official channels: Medicare.gov or licensed agents. Unsolicited enrollment calls are a red flag.
How to Protect Your Medicare Number
Your Medicare card has a unique Medicare Beneficiary Identifier (MBI): a random 11-character combination of numbers and letters. This replaced the old Social Security number-based Medicare number to reduce identity theft.
Treat your Medicare card like a credit card. Carry it when you need it for medical appointments, but do not carry it every day or leave it in your wallet routinely if not needed.
Only give your Medicare number to:
- Your doctors, hospitals, pharmacies, and other providers
- Your Medicare plan (Medigap, Part D, or Medicare Advantage insurer)
- Official Medicare representatives you contact directly
Never give your Medicare number to:
- Anyone who contacts you by phone, email, or text requesting it unexpectedly
- Someone offering free services or equipment in exchange for it
- An insurance agent who pressures you for it before fully explaining a plan
How to Review Your Medicare Summary Notice (MSN)
One of the most effective fraud prevention tools you have is your Medicare Summary Notice (MSN): a quarterly statement Medicare sends listing all the services billed on your behalf.
Review your MSN carefully:
- Check every service, date, and provider listed
- Look for services you did not receive, dates you were not at a provider’s office, or providers you do not recognize
- Compare the MSN with your own records of medical appointments and services
If you have a Medicare Advantage plan, you receive an Explanation of Benefits (EOB) from your insurer instead of an MSN. Review it with the same care.
If you find an error or suspect fraud:
- Contact the provider first. Some discrepancies are billing errors that can be corrected.
- If you believe it is fraud, report it (see below).
You can also review your claims online anytime at MyMedicare.gov.
How to Report Medicare Fraud
If you suspect Medicare fraud, report it. Your report can stop a scammer from victimizing others and may help you recover costs.
1-800-MEDICARE (1-800-633-4227)
The official Medicare help line. You can report suspected fraud and ask questions about your claims.
HHS Office of Inspector General (OIG)
Online: oig.hhs.gov/fraud/report-fraud
Phone: 1-800-HHS-TIPS (1-800-447-8477)
The OIG investigates health care fraud, waste, and abuse.
Senior Medicare Patrol (SMP)
Senior Medicare Patrol programs in every state train volunteers to help beneficiaries detect and report fraud. To find your local SMP: smpresource.org
Federal Trade Commission (FTC)
For general consumer fraud complaints: reportfraud.ftc.gov
Your State Attorney General
Most states have consumer protection divisions that handle Medicare fraud complaints at the state level.
What Happens After You Report Fraud?
When you report suspected Medicare fraud, your report is reviewed by the appropriate agency. Not every report results in an investigation or prosecution, but reports are used to identify patterns and prioritize enforcement.
If you are a victim of Medicare fraud, you generally are not held financially responsible for fraudulent charges. Medicare should not reduce your benefits because someone else committed fraud in your name, though you may need to work with Medicare to correct your records.
What the Government Is Doing About Medicare Fraud
The federal government actively pursues Medicare fraud through several mechanisms:
HEAT Task Force. The Health Care Fraud Prevention and Enforcement Action Team coordinates law enforcement actions targeting fraud.
Fraud prevention in claims processing. CMS uses data analysis to identify suspicious billing patterns before payments are made.
Recovery Audit Contractors (RACs). These contractors review Medicare claims after the fact to identify overpayments and errors.
Despite these efforts, fraud remains a major problem. The best defense is an informed beneficiary who reviews their claims and reports suspicious activity.
Frequently Asked Questions
My Medicare number was used without my permission. What should I do?
Contact 1-800-MEDICARE immediately to report the fraud. The program can flag your account and help you review claims filed in your name. You may be issued a new Medicare Beneficiary Identifier (MBI).
Someone called and said I would receive a free knee brace if I provide my Medicare number. Is this legitimate?
Almost certainly not. Legitimate medical equipment is prescribed by a doctor, ordered through a Supplier enrolled with Medicare, and not offered in unsolicited phone calls. Do not give out your Medicare number in response to unsolicited contacts.
I think my doctor billed for an appointment that never happened. What should I do?
First, contact the doctor’s billing office. It may be an error. If you believe it is intentional fraud, report it to 1-800-MEDICARE and the HHS OIG.
A family member is being pressured to sign up for a Medicare plan by someone who came to their home. Is this allowed?
Medicare Advantage and Part D plans are not allowed to conduct uninvited door-to-door solicitation. This is a violation of CMS marketing rules. Report the incident to 1-800-MEDICARE.
Bottom Line
Medicare fraud is real, widespread, and often targets the people who can least afford to be victimized. Protecting yourself starts with knowing the warning signs, guarding your Medicare number, and reviewing your MSN every quarter.
When in doubt, hang up. Do not give personal information to anyone who contacts you unexpectedly, regardless of what they claim.
And remember: when you report fraud, you protect not only yourself but every other Medicare beneficiary.
For guidance on your Medicare coverage and to work with licensed, trustworthy advisors, reach out to REMEDIGAP.
This article is for educational purposes. For fraud reporting, contact 1-800-MEDICARE or oig.hhs.gov. Medicare fraud laws and enforcement details may change.
💡 Your next step: Once you have Medicare, most people add a supplement plan to cover out-of-pocket costs. Compare Medicare Supplement plans to find the right fit.
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Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder
Fact Checked by Joann Quinn
Chief Compliance Officer
As a licensed insurance broker, REMEDIGAP upholds the principles of integrity in our editorial standards and ensures transparency in how we receive compensation from our insurance partners.