The Scale of Medicare Fraud
Medicare fraud costs the federal government an estimated $60–$90 billion per year — roughly 10% of total Medicare spending. Fraud takes many forms, from providers billing for services never rendered to organized criminal rings stealing beneficiary identities. Increasingly, scammers directly target Medicare beneficiaries through phone calls, emails, and even door-to-door visits.
Common Medicare Scams Targeting Beneficiaries
The Medicare card scam
Callers claim to be from Medicare and say you need a "new Medicare card" — often citing a supposed system upgrade or redesign. They ask you to verify your Medicare number, Social Security number, or bank information to "activate" the card. Medicare will never call you to ask for your Medicare number. They already have it.
Fake plan enrollment calls
During open enrollment season, scammers impersonate insurance agents and pressure you to enroll in a specific Medicare Advantage or Part D plan. They may promise benefits that do not exist or claim your current plan is being cancelled. Legitimate agents do not cold-call to sell Medicare plans — this is prohibited by CMS marketing rules.
Free medical equipment offers
You receive a call offering free back braces, knee braces, or genetic testing kits. The caller asks for your Medicare number to "verify eligibility." They then bill Medicare for equipment or tests you never needed, never received, or that were medically inappropriate. This generates fraudulent claims under your name.
COVID and prescription drug scams
Scammers offer free COVID tests, vaccines, or prescription drug discount cards in exchange for your Medicare number. While vaccines and certain tests are genuinely free, you should only access them through legitimate pharmacies and healthcare providers — never through unsolicited calls or websites.
How to Protect Yourself
- Guard your Medicare number like a credit card number — do not share it with anyone who contacts you unsolicited
- Review your Medicare Summary Notice (MSN) every quarter — check for services you did not receive or providers you did not visit
- Never give personal information to unsolicited callers, even if they claim to be from Medicare, Social Security, or your insurance company
- Hang up on pressure tactics — legitimate Medicare representatives never pressure you to make immediate decisions
- Verify independently — if someone claims to be from Medicare, hang up and call 1-800-MEDICARE directly
- Shred Medicare documents before discarding them — dumpster diving for Medicare numbers is a real tactic
Signs of Provider Fraud
Not all fraud comes from external scammers — some comes from healthcare providers themselves. Watch for:
- Being billed for services you did not receive
- Receiving duplicate bills for the same service
- Being billed for more expensive procedures than what was performed (upcoding)
- A provider ordering unnecessary tests or procedures
- Being asked to provide your Medicare number for a "free" screening or service at a health fair
How to Report Medicare Fraud
| Who to Contact | When |
|---|---|
| 1-800-MEDICARE (1-800-633-4227) | Questions about suspicious charges on your MSN |
| OIG Hotline: 1-800-HHS-TIPS | Suspected provider fraud, kickbacks, or abuse |
| Senior Medicare Patrol (SMP) | Free volunteer program in every state for fraud education and reporting |
| State Attorney General | Scams and identity theft affecting state residents |
| FTC (reportfraud.ftc.gov) | General consumer fraud and identity theft |
If Your Medicare Number Is Compromised
If you believe your Medicare number has been stolen or used fraudulently:
- Call 1-800-MEDICARE immediately to report the breach
- Request a new Medicare Beneficiary Identifier (MBI) — Medicare can issue a replacement number
- Place a fraud alert on your credit reports through the three bureaus
- Monitor your MSN and Explanation of Benefits carefully for the next 12 months
- Contact your local State Health Insurance Assistance Program (SHIP) for free counseling