How Seniors Can Spot and Report Medicare Fraud

What Is Medicare Fraud?

Medicare fraud involves intentionally giving false information to obtain a payment or benefit that someone isn’t entitled to. Examples include billing Medicare for a service that wasn’t provided or using another person’s Medicare number to submit claims. An unfamiliar charge is a reason to investigate, but it may turn out to be a billing error rather than intentional fraud.

A Medicare scam is an attempt to deceive you—for example, a caller posing as a Medicare representative to get your number. If someone then uses that number to submit false claims, the scam can lead to fraud and medical identity theft. We think this distinction is useful because the first response to an unfamiliar charge is to ask the provider or plan about it, while the first response to an unexpected request for your number is to stop the conversation and verify the caller independently.

Common Types of Medicare Fraud and Scams

These are examples worth checking or reporting. Seeing one on a statement doesn’t prove intent, so ask about an unfamiliar charge before assuming it was fraudulent:

• Billing Medicare twice for the same treatment or service
• Charging for equipment or tests you never received or needed, such as an unnecessary back brace
• Offering fake Medicare drug plans that don’t actually exist
• Using a stolen Medicare number to bill for hospice or other services fraudulently
• Calling or texting to “verify” your Medicare number, then using it to bill for services you never received

A scam attempt may never produce a Medicare claim. For instance, a caller asking for your number is a warning sign, even if you hang up before sharing it. That’s still worth telling a caregiver or reporting if the contact continues.

>> Related Reading: Common Scams That Target Seniors

Open Enrollment Is Prime Scam Season

Medicare Open Enrollment runs from October 15 through December 7 each year. It’s a useful time to compare coverage, and scammers may take advantage of the extra plan advertising and calls. If someone pressures you to enroll immediately or claims to be calling from Medicare to recommend one particular plan, end the call. You can compare plans through Medicare.gov or a trusted counselor using contact information you found yourself.

Why Medicare Scams Matter to Older Adults

Medicare-related scams are relevant to many older adults because they use Medicare for routine care, prescriptions, or both. A convincing caller may know the name of a real provider or describe a plausible benefit. That can make the request sound ordinary when it isn’t. Being approached by a scammer says nothing about a person’s judgment; these schemes are designed to resemble everyday health-care tasks.

For caregivers, the most helpful question is often a simple one: “Does this statement match an appointment, prescription, or piece of equipment we remember?” Keep a short calendar of care and ask about anything that doesn’t match. If you help someone review statements or speak with their plan, make sure they want that help and ask the organization what authorization it requires.

>> See the Data: Senior Identity Theft Statistics

Warning Signs to Watch For

Some signs appear on claims; others are attempts to get your information. Watch for both:

• An Original Medicare Summary Notice showing care, equipment, or supplies you didn’t receive—or an unfamiliar claim on an Explanation of Benefits from your Medicare Advantage or drug plan
• A provider on a statement you don’t recognize, especially when the service and date don’t match your own records
• A notice from your plan that a particular benefit has been used up when the care you received doesn’t account for it
• Unsolicited calls, texts, or visits asking you to “confirm” your Medicare number
• Pressure to enroll in a plan immediately, without time to think it over
• A “free” offer, like genetic testing or a back brace, that requires your Medicare number to claim

An unsolicited call is a warning to protect your information; an unfamiliar claim calls for a closer look at your records. Neither tells you on its own exactly what happened.

>> Learn More: Identity Theft Protection for Seniors

How to Protect Yourself

A few consistent habits can help protect your information and make a suspicious Medicare claim easier to catch.

Guard Your Information

• Treat your Medicare number like a credit card number; never share it with an unsolicited caller
• Destroy old Medicare cards with scissors or a shredder once a replacement arrives
• Don’t trust a caller who claims Medicare sent them to recommend a particular plan; compare coverage using Medicare.gov or a counselor you contacted yourself
• Verify any plan or coverage change directly through Medicare.gov instead of clicking a link in an unsolicited email or text

Stay Alert

Checking your Medicare claims is still the most direct way to spot a questionable charge. We also see a role for identity monitoring when a scam may have exposed information beyond your Medicare number. Coveron can alert users to certain dark-web exposures, while its Identity Theft Protection and Full Protection plans add credit and financial-account monitoring. If you’re considering a monitoring service, our Coveron and Aura comparison can help you weigh the features you’d actually use.

Coveron doesn’t review Medicare claims, so we’d use it alongside these habits rather than in place of them:

• If you have Original Medicare, compare your Medicare Summary Notices for Part A and Part B care with your appointment calendar. If you also have a separate Part D drug plan, review that plan’s Explanation of Benefits for prescriptions. Medicare Advantage members should check claims and statements from their plan.3 Original Medicare generally mails Medicare Summary Notices every six months when claims have been processed, but you can review claims sooner through your secure Medicare.gov account.
• Create a secure Medicare.gov account to check Original Medicare claims after Medicare processes them. For more current Medicare Advantage or drug-plan claim information, contact your plan.
• Be especially cautious of calls and mail during Open Enrollment season, October 15 through December 7
• If you want help, review statements with a trusted family member or caregiver and compare them with a shared appointment calendar. Ask your plan or provider how to authorize that person to speak on your behalf.

How to Report Medicare Fraud

You don’t have to prove fraud before asking for help. Instead, work through these steps according to what happened:

1. Call the provider or plan shown on the unfamiliar claim using a number you found independently. Ask what was billed and whether it could be an error. Write down the explanation.
2. If an Original Medicare charge remains suspicious, call 1-800-MEDICARE (1-800-633-4227). If the charge appears on a Medicare Advantage or Part D statement, contact that plan about its claim; you can also report suspected Medicare fraud to 1-800-MEDICARE.
   If you believe your Medicare number has been stolen or compromised, contact Medicare immediately, even if you haven’t found a suspicious claim. Medicare can help you determine whether you need a new Medicare number. Medicare Advantage and Part D members can also report suspected fraud to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-772-3379.
3. For free, one-on-one help understanding and reporting a concern, call your local Senior Medicare Patrol at 1-877-808-2468.
4. You can also report suspected Medicare fraud through the HHS Office of Inspector General’s fraud hotline. Call 1-800-447-8477 or use its online reporting form.
5. If someone tried to deceive you by phone, text, email, or a fake plan offer, report that scam at ReportFraud.ftc.gov.
6. If someone used your identity to get care or submit claims, report the identity theft at IdentityTheft.gov and follow its recovery plan.
7. Keep a written log of the statements you reviewed, the people you spoke with, the dates of your calls, and any confirmation numbers. That record will help if you need to follow up.

>> Compare Options: Best Identity Theft Protection for Seniors

Conclusion

The most useful habit is to compare the care you received with the claims your Medicare program or plan recorded. An unfamiliar line item deserves a call to the provider, while an unexpected request for your number deserves a firm pause and an independent callback. You can ask a caregiver to help with the paperwork, and the Senior Medicare Patrol can help you work through a concern for free. An identity theft protection service, such as Coveron, may alert you to other uses of your personal information, but it can’t check a Medicare claim for you.