Medicare Fraud: How To Protect Yourself

Medicare Fraud: How To Protect Yourself

As a Medicare subscriber, you have access to insurance benefits that can help you save money on your health care expenses. However, when those Medicare benefits are misused, the cost is high. Not only do Medicare scams cost the government billions of dollars each year, but undergoing unnecessary medical procedures can also increase health risks. If you allow anyone to use your Medicare card or number for fraudulent purposes, you might even face legal trouble yourself.

Here's what you need to know to protect yourself from Medicare fraud.

Common Medicare Scams

To guard against Medicare fraud, it can help to be aware of some of the most common scams. Some typical kinds include when:

  • A doctor, medical facility or other health care provider bills Medicare for services not provided, or for unnecessary services.

  • A medical supplier bills Medicare for medical supplies and equipment that were provided without a doctor's prescription.

  • A doctor charges Medicare with a more expensive service than the one that was provided, a practice known as "upcoding."

  • A medical facility charges lab services as separate tests in order to get a higher Medicare payment, a scam called "unbundling."

  • A supplier offers a patient a gift, bribe or kickback in exchange for "free" but unnecessary equipment billed to Medicare.

Warning Signs of Medicare Fraud

Here are a few scenarios that should serve as red flags for possible Medicare scams.

  • A health care provider or supplier says your medical service or equipment is free — they just need your Medicare number for their records.

  • A doctor advertises "free" consultations for Medicare patients.

  • A supplier claims to represent Medicare or a branch of the federal government.

  • A provider uses pressure or scare tactics to sell you expensive medical equipment or diagnostic tests.

  • A medical supplier suggests you ask your doctor for services, equipment or supplies you don't need.

What To Do if You Suspect Fraud

If you notice a charge on your Medicare claims statement that seems wrong, contact your provider. The provider or a staff member may be able to explain why the charge is there, or they may discover an error and correct it.

If your provider can't resolve your questions and you still suspect fraud, you can report it in one of the following ways.

  • Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

  • Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.

  • Visit to file a report online.

As you prepare to file your fraud report, make sure you have this information on hand:

  • Your Medicare number.

  • The name of the doctor, facility or supplier you suspect of Medicare fraud.

  • Dates and payment amounts related to any specific Medicare claim you suspect is fraudulent.

  • The date of the Medicare Summary Notice on which the suspicious charge is listed.

  • Any other information or evidence you may have that fraud has occurred.

Helpful Anti-Fraud Resources

These resources can help you stay on the watch for Medicare fraud and report any scams you discover.

  • is a free, secure online service that provides 24-hour access to your personal Medicare-related information, including your Medicare Summary Notices.

  • Medicare's automated phone system provides information about Original Medicare claims processed within the past year. To access the system, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

  • "Protecting Yourself and Medicare from Fraud" is a free online booklet from the Centers for Medicare & Medicaid Services

  • Senior Medicare Patrol is an educational program that exists in every state, the District of Columbia, Guam, and Puerto Rico. Visit or call 1-877-808-2468 to find your local SMP program.

Dos and Don'ts in the Fight Against Medicare Fraud

  • Do learn how your Medicare plan works, including what it does and doesn't cover.
  • Don't throw away your health care bills and receipts.
  • Do check the statements and receipts from your health care providers against the claims in your Medicare statements.
  • Don't agree to have a provider put a false diagnosis on a claim so Medicare will pay the bill.
  • Do contact your provider if you think there's been a billing error charging Medicare with a service you didn't receive.
  • Don't give your Medicare card or number to anyone except your doctor or other Medicare provider.

Follow this guide as you navigate your benefits to better protect yourself against Medicare fraud.

Sonya Stinson AuthorThumbnail

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