Is There a Medicare Scam Going Around?

Medicare scams are a persistent threat, impacting beneficiaries nationwide. These fraudulent schemes exploit trust and personal information, leading to financial losses and compromised medical identities. Understanding scam tactics and remaining vigilant are essential to protect yourself and safeguard the Medicare program. Awareness is a primary defense against these deceptive practices.

Common Medicare Scams and Warning Signs

Scammers frequently target Medicare beneficiaries through unsolicited contact, including calls, emails, texts, or home visits. One common scheme involves fake Medicare cards, where fraudsters claim beneficiaries need a new card and request personal information to “update” their records. Medicare will not call about a new card, as new cards without Social Security numbers were issued in 2018 with no further updates planned.

Durable medical equipment (DME) fraud is another prevalent scam. Individuals might be offered “free” braces, wheelchairs, or other equipment medically unnecessary or unrequested. Scammers then bill Medicare for these items without the beneficiary’s knowledge or a physician’s order.

Genetic testing scams involve fraudsters offering “free” DNA screenings or cheek swabs to detect diseases like cancer or Alzheimer’s. They collect Medicare numbers and other personal data, then bill Medicare for unneeded tests. These tests are rarely covered by Medicare unless medically necessary and ordered by a treating physician.

Prescription drug scams involve billing Medicare for medications not received, providing different drugs than prescribed, or offering “free” or discounted drugs for Medicare information. Scammers might also bill for automatic refills of unneeded prescriptions. Imposter scams are widespread, with individuals pretending to be from Medicare, Social Security, or the IRS to extract sensitive data.

Warning signs include unsolicited contact, demands for personal information like Medicare or Social Security numbers, or pressure to act immediately. Scammers often create urgency or threaten loss of benefits. Promises of “free” services, equipment, or gifts for your Medicare number are red flags. Be cautious of requests for payment in unusual forms, such as gift cards.

Safeguarding Your Personal Information

Protecting your Medicare card is a key defense against fraud. Treat your Medicare card with the same care as a credit card; it contains sensitive information that can be used to commit identity theft and fraudulent billing. Only provide your Medicare number to your doctor, pharmacists, other healthcare providers at the time of service, or to your health plan or State Health Insurance Assistance Program (SHIP).

Regularly reviewing your Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) is a proactive measure to detect suspicious activity. These documents detail services and equipment billed to Medicare. Look for charges for services you did not receive, equipment you did not order, or visits you did not attend. If you have Original Medicare, you can access your claims by logging into your secure Medicare account at Medicare.gov.

Medicare typically does not make unsolicited calls, emails, or home visits asking for your Medicare number or financial details. If someone contacts you unexpectedly claiming to be from Medicare and requests personal information, it is likely a scam. Legitimate Medicare representatives will generally only call if you have previously contacted them or if your Medicare plan is returning a call you initiated.

General security habits further enhance protection. Shred any documents containing your Medicare or Social Security number or other personal financial information before discarding them. Be skeptical of offers that seem too good to be true, especially those promising free medical services or equipment. Using strong, unique passwords for all online accounts, particularly those related to healthcare or finance, helps protect your digital information.

Taking Action Against Scams

If you receive a suspicious call, email, or visit related to Medicare, the immediate action is to disengage. Hang up on unsolicited calls, delete suspicious emails or texts without clicking links, and do not engage with individuals who come to your door claiming to be from Medicare. Do not provide any personal information or confirm details.

Reporting suspected Medicare fraud helps combat these schemes. Contact your local Senior Medicare Patrol (SMP) program, which educates beneficiaries to prevent, detect, and report healthcare fraud. The national toll-free number for the SMP Resource Center is 1-877-808-2468.

You can also report suspected fraud directly to Medicare by calling 1-800-MEDICARE (1-800-633-4227). If you have a Medicare Advantage Plan or Medicare drug plan, contact the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379). The Department of Health and Human Services Office of the Inspector General (HHS OIG) has a fraud hotline at 1-800-HHS-TIPS (1-800-447-8477), or you can file a complaint online at tips.oig.hhs.gov. The Federal Trade Commission (FTC) also accepts reports of fraud at ReportFraud.ftc.gov.

If your personal information has been compromised, take steps to protect yourself from further identity theft. Monitor your financial accounts and credit reports for unauthorized activity. Consider placing a fraud alert on your credit reports with one of the three nationwide credit bureaus (Equifax, Experian, or TransUnion) to make it harder for someone to open new accounts in your name.