Medicare scams are a significant problem, costing billions of dollars each year. Scams may include identity theft, false claims, and durable medical equipment (DME) fraud.
Medicare scams occur when someone pretends to be from Medicare or connected to the program to obtain personal information or money.
These scams tend to increase during Medicare’s open enrollment period (October 15 to December 7). During this period, Medicare beneficiaries are encouraged to review their coverage and make any necessary changes.
It is important to know the signs of scams and understand how to help protect against them.
Do not give personal information to anyone who contacts you unexpectedly and claims to be from or connected to Medicare.
It helps to be aware of certain signs of Medicare scams so that people can protect themselves against them.
Offers of free items or services
Individuals should be suspicious of any offers that involve free:
- medical services
- supplies
- prescription medications
Scammers will often offer older adults valuable medical equipment. They then ask for their Medicare number and file high cost Medicare claims in their name.
A person also needs to be wary of any genetic testing or screenings that their doctor did not order. This is a known scam where scammers bill Medicare for unnecessary genetic testing.
Pressure to switch Medicare plans
Scammers claiming to be associated with Medicare may claim that a person is preapproved for a new healthcare plan or prescription drug plan that has lower payments and better benefits.
They may also tell the individual there is a fee to enroll in this new plan.
Threats to cancel coverage
Scammers may call and state that there is an issue with a person’s Medicare account, such as fraudulent activity. They may then tell the individual that their benefits will be canceled if they do not verify their personal information and enroll in a new plan.
Claims a person is eligible for a refund
A common tactic for scammers is to tell older adults that, due to changes in their coverage, they are eligible for a Medicare refund.
The scammer may ask for a person’s Medicare number and bank account information.
It is important to protect oneself from Medicare scams.
In 2024, Medicare fraud and scams resulted in losses of $1.6 billion.
Medicare scams not only take money from the United States taxpayers, government, and Medicare, but they also cost Medicare beneficiaries in:
- time
- stress
- money
- health
However, there are various ways a person can help protect themselves from Medicare scams.
Avoid sharing Medicare numbers
Individuals should only share their Medicare number or Social Security Number with their doctor, pharmacy, or known people who work with Medicare.
If a person receives an unexpected phone call from someone claiming to be connected with Medicare, they need to avoid sharing any personal information with them.
Medicare will not usually call unless it is in response to a request. If a Medicare representative does call, they will not need personal information because they will already have it.
Don’t trust caller ID
Scammers can spoof (fake) a phone number. This means that their phone’s caller ID may show Medicare’s name or number, even if Medicare is not actually calling.
To be sure the call is legitimate, hang up and call Medicare directly at 800-633-4227.
Do not click suspicious links
Not only can scammers fake phone numbers, but they can also fake emails and make it appear that an email is coming from Medicare.
These emails can even take a person to a website that looks authentic. Do not respond to any unexpected emails or texts, and do not click on any links.
If an individual needs to update their information or receive a text or email telling them to do so, they can go directly to Medicare.gov and log in to their account. They can also call Medicare at 800-633-4227.
Do not be afraid of threats
Scammers may threaten to terminate a person’s Medicare benefits if they do not do what they ask. This often involves signing up for a specific plan.
If an individual is eligible for Medicare, their benefits cannot be terminated for these reasons.
Ignore persuasions to choose a certain plan
If someone tries to sell a plan that is “preferred by Medicare,” do not speak with them. Medicare does not endorse any specific plans or policies.
Destroy old Medicare cards
Some scammers may claim that a person needs to return their old card to Medicare.
This is not true.
If an individual receives a new Medicare card, they need to destroy the old one immediately by cutting it up or shredding it. Medicare does not need the old card back.
Protect health records, and do not accept unexpected genetic testing kits
Do not allow anyone but a doctor and other healthcare professionals to review personal medical records.
If a person receives a shipment of a genetic testing kit that their doctor did not order, they need to refuse the shipment and return it to the sender.
Review Medicare information
It is important that a person review their Medicare summary notice carefully for any unexpected charges.
A summary notice is a letter Medicare will send that lists all the healthcare services, supplies, and equipment a person has received.
Finding unbiased Medicare advice
If a person is looking for unbiased advice on Medicare coverage, plans, or scams, they can contact the State Health Insurance Assistance Program (SHIP).
They can do this by calling 877-839-2675 or locating their local SHIP office.
If a person believes they have experienced any kind of Medicare scam or fraud, it is important to report it.
Individuals can do this in the following ways:
Reporting Medicare scams and fraud is important and may help prevent them from happening to others.
Medicare scams are on the rise and tend to be more common during the open enrollment period.
Medicare scams can happen to anyone. This is why it is important to know the signs, how to protect oneself, and how to report scams and fraud.
To report scams and fraud directly to Medicare, a person can call 800-633-4227.