Medicare Fraud: How to Recognize It, Report It, and Protect Yourself
Medicare fraud costs the program tens of billions of dollars annually -- and beneficiaries are often the first line of defense. Here is how to spot fraud, protect your Medicare number, and report suspicious activity.
Medicare Fraud: How to Recognize It, Report It, and Protect Yourself
Medicare fraud costs the federal government an estimated $60-$90 billion annually -- and it drives up costs for all beneficiaries. Fraudsters target Medicare beneficiaries with sophisticated scams, and the consequences can include identity theft, incorrect medical records, and disrupted care. Here is how to protect yourself.
Common Medicare Fraud Schemes
Billing for services not provided: The most common form of fraud -- a provider bills Medicare for services, equipment, or supplies you never received.
Upcoding: Billing for a more expensive service than what was actually provided (e.g., billing for a complex office visit when only a brief check-in occurred).
Unbundling: Billing separately for services that should be billed together at a lower combined rate.
Phantom providers: Fraudsters create fake provider identities to bill Medicare for services that were never provided.
Durable medical equipment fraud: Unsolicited DME delivered to your home and billed to Medicare without a legitimate prescription. Common items include back braces, knee braces, and diabetic supplies.
Telemarketing scams: Callers claiming to be Medicare representatives offering free equipment, genetic testing, or other services in exchange for your Medicare number.
Genetic testing scams: Fraudsters offer free cheek swabs for genetic testing (cancer screening, pharmacogenomics) and use your Medicare number to bill for tests you did not need or request.
COVID-19 scams: Offers of free COVID tests, vaccines, or treatments in exchange for your Medicare number.
How to Protect Your Medicare Number
Your Medicare number is as sensitive as your Social Security number. Treat it accordingly:
- Never give your Medicare number to anyone who contacts you unsolicited -- by phone, email, or in person
- Medicare will never call you to sell you anything or ask for your Medicare number to send you a new card
- Do not carry your Medicare card in your wallet -- memorize your number or keep a copy at home
- Be skeptical of "free" offers -- if someone is offering free equipment or services in exchange for your Medicare number, it is likely fraud
Reading Your Medicare Summary Notice
Your Medicare Summary Notice (MSN) -- mailed quarterly -- lists all services billed to Medicare on your behalf. Review it carefully:
Check for:
- Services you did not receive
- Dates of service that do not match your records
- Providers you do not recognize
- Equipment or supplies you never received
- Duplicate billing for the same service
If you find an error: Contact the provider first -- it may be a billing mistake. If the provider cannot resolve it, call 1-800-MEDICARE.
How to Report Medicare Fraud
1-800-MEDICARE (1-800-633-4227): Report suspected fraud directly to Medicare.
HHS Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477) or oig.hhs.gov
Senior Medicare Patrol (SMP): A federally funded program that helps beneficiaries prevent, detect, and report Medicare fraud. Find your local SMP at smpresource.org. Florida's SMP is operated through the Florida Department of Elder Affairs.
Florida Attorney General: myfloridalegal.com -- for Florida-specific fraud
Whistleblower Protections and Rewards
If you report Medicare fraud that leads to a successful government recovery, you may be entitled to a portion of the recovered funds under the False Claims Act. Consult an attorney if you have evidence of systematic fraud.
What Happens After You Report
Reports are reviewed by Medicare contractors and the HHS Office of Inspector General. Investigations can result in:
- Recovery of fraudulently billed funds
- Provider exclusion from Medicare
- Civil and criminal penalties
- Imprisonment for serious fraud
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.
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About the Author
William Gray
Independent Medicare BrokerUS Air Force Veteran · Florida Medicare Specialist
William Gray is an independent Medicare insurance broker based in Daytona Beach and Palm Coast, FL. A US Air Force veteran (A-10 crew chief, Germany), he spent years in corporate insurance before going independent to serve Florida seniors directly. He has helped more than 1,000 clients across Northeast Florida compare Medicare Advantage, Medigap, and Part D plans — always at no cost to the client.
