Medicare Fraud

AARP

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En español

Published June 17, 2019

/ Updated May 19, 2023

Medicare and its 65 million beneficiaries are susceptible to an increasing number of fraud activities and scammers, costing the program billions of dollars each year. Scammers’ primary aim is to defraud Medicare itself; however, their schemes often rely on targeting beneficiaries directly, stealing their identities or enlisting them as unwitting accomplices.

Medicare fraud usually involves rogue health care providers or medical suppliers who bill the program for services, equipment or medication they don’t provide or otherwise inflate the cost of those items. Some will even falsify patients’ diagnoses to justify unnecessary tests, surgeries and other procedures or write prescriptions for patients they’ve never examined. Other provider or supplier Medicare scams use genuine patient information, sometimes obtained through identity theft, to create fake claims.

During the coronavirus pandemic, scammers targeted beneficiaries with offers of free COVID-19 tests in exchange for their Medicare number or other personal information, according to the U.S. Department of Health and Human Services’ Office of Inspector General. The scammers use the data for medical identity theft, and victims can end up bearing the cost of an unapproved test or treatment.

Common Medicare scams

Disreputable home health care agencies try to sign people up for services that Medicare pays for but that patients never receive.
Identity thieves call Medicare beneficiaries and offer to send them a new Medicare card made of heavy-duty plastic or containing a chip, like a credit card. Instead, they steal the person’s Medicare number and file fake claims in their name. Medicare doesn’t offer a chip card, and you can order or download a replacement Medicare card at any time from your online Medicare account.
Telemarketers call beneficiaries with offers of free state-of-the-art braces to relieve joint pain. Instead, consumers receive ordinary ankle or knee wraps or nothing at all, but Medicare gets a bill for thousands of dollars.
Unscrupulous clinics write phony prescriptions or order unnecessary tests and procedures to steal from Medicare. Another ploy: providing treatment that Medicare doesn’t pay for and then billing it as a different, covered service.

These scams just scratch the surface. Others can be more complex and costly.

One scam involves swindlers calling older Americans or showing up at health fairs or senior living communities offering DNA tests to uncover cancer risks. They may even mail you a testing kit without prior contact.

They claim Medicare will cover the tests. But in reality, Medicare pays only for genetic testing in very limited circumstances, so you’re stuck with a hefty bill.

In 2021, one genetic testing scam netted a 10-year prison term for a Florida telemarketer convicted of federal fraud charges for his role in a kickback-fueled operation that billed Medicare for more than $3 million for genetic tests.

Beneficiaries bear some of the cost of rampant Medicare fraud. The program’s losses translate into higher deductibles and copayments, and can eventually be harmful to your health.

If someone obtains your Medicare number and bills the program for phony prescriptions or unnecessary medical equipment, you could be denied coverage later for drugs or devices you genuinely need. Take precautions to avoid getting mixed up in Medicare fraud.

Warning signs

Clinics or other health care facilities that advertise free services or consultations specifically for Medicare patients.
Doctors or other providers that claim to know how to get Medicare to pay for items or services not normally covered.
Emails, robocalls or other communications offering medical services or supplies for free if you provide your Medicare number.
Fraudulent information on Medicare summary notices — the statement you get from Medicare listing recent claims from health care providers — that include devices, procedures or services you didn’t receive. Also watch out for charges that appear twice for services you received once.

VIDEO: 3 Ways to Protect Your Medicare Account

How to protect yourself

Decline if someone wants to bill you for a DNA test or other service in case Medicare declines to pay.
Never accept money or gifts to use the services of a medical provider or device supplier. Some scammers give kickbacks and bribes to obtain Medicare information for phony claims.
Note the dates of medical appointments and services received on a calendar and save all receipts and statements from providers.
Refuse to talk to anyone who knocks on your door or approaches you in person claiming to represent Medicare or selling Medicare-covered supplies or services, such as braces or COVID-19 tests.
Reject high-pressure tactics, such as a telemarketer’s threat that Medicare will declare you ineligible unless you accept the offer of a “free” service or piece of equipment quickly.
Scrutinize your Medicare summary notices as soon as possible after getting them. Make sure the dates and services listed are correct. If something doesn’t look right, call your medical provider’s office.
Share your Medicare number only with trusted health care providers.
Sign up for electronic Medicare summary notices to keep closer tabs on your account. These are emailed monthly to participating beneficiaries, unlike paper statements that Medicare sends quarterly. You also can access Medicare claims information within 24 hours of when Medicare processes them on your online Medicare account.
Turn down offers of free medical supplies or equipment in exchange for your Medicare number.
Withhold personal information from anyone who calls unexpectedly and claims to be from Medicare, even if your caller ID shows a Medicare phone number. Scammers use caller ID spoofing to mask their location. A customer service representative from Medicare can only call you if you’ve called and left a message at 800-MEDICARE or a representative said that someone would call you back. A Medicare Advantage or Part D drug plan may call you if you’re already a member of the plan.

To report Medicare fraud

Contact the Senior Medicare Patrol for your area. The patrols, which the federal government finances, are available in every state and the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands. Volunteers and staff can help you detect and report Medicare scams and answer questions about suspicious activity. You should start here because they will walk you through the fraud reporting process.
Call Medicare at 800-633-4227 for fraud concerns with your Parts A and B coverage. If the issue is a suspicious charge on your Medicare Part D prescription drug plan, call 877-772-3379 and reach out to your private plan directly.
Get in touch with the Office of Inspector General of the U.S. Department of Health and Human Services online or at 800-447-8477. The OIG investigates fraud.

The Centers for Medicare & Medicaid Services booklet Protecting Yourself & Medicare from Fraud has additional details on detecting, preventing and reporting Medicare fraud.

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