What Can Someone Do With Your Medicare Number?

A Medicare number serves as a unique identifier for individuals enrolled in the federal health insurance program. This alphanumeric code, distinct from a Social Security number, is printed on a Medicare card and is essential for processing medical claims and confirming eligibility for coverage. Because it links directly to an individual’s healthcare benefits and personal information, safeguarding this number is important for protecting one’s medical and financial well-being.

Common Misuses of Your Medicare Number

A compromised Medicare number can enable various forms of fraudulent activity. One prevalent misuse is medical identity theft, where criminals use the number to obtain medical services, equipment, or prescription drugs in the legitimate beneficiary’s name. This can lead to inaccurate medical histories, potentially affecting future diagnoses and treatments. For instance, a scammer might use the number to receive a prescription for a controlled substance, which then appears on the beneficiary’s medical record.

Billing fraud is another scheme, involving fraudsters submitting claims to Medicare for services or equipment that the beneficiary never received. They might bill for unnecessary items, such as durable medical equipment (DME) like back braces, without the beneficiary’s knowledge or request. This type of fraud can quickly deplete a beneficiary’s available benefits, leading to denials for legitimate future care as benefits appear exhausted.

Prescription drug fraud occurs when a stolen Medicare number is used to acquire medications, often controlled substances, for illicit sale or personal use. This creates a false record of drug consumption for the beneficiary and contributes to prescription drug diversion. Impersonation for financial gain related to healthcare includes using the number to enroll in different Medicare plans without consent, potentially resulting in higher costs or changes in coverage.

Identifying Potential Fraud and Misuse

Recognizing the signs of Medicare number misuse helps protect your benefits and identity. A key method involves reviewing your Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs). These documents, typically sent every three to four months, detail all services and supplies billed to Medicare under your name. Compare the listed services and dates with your personal records to ensure accuracy.

Unfamiliar charges, services, or providers appearing on your MSN or EOB can indicate fraudulent activity. For example, a charge for a doctor’s visit on a day you were not at the clinic, or for equipment you never received, raises concerns. Another warning sign is receiving unexpected medical bills or collection notices for services you did not obtain. This occurs if a fraudster used your information, and the provider attempts to collect payment for services rendered to the imposter.

Being denied coverage for necessary services because your records show you have already received maximum benefits indicates potential fraud. Similarly, receiving unsolicited medical equipment or supplies through the mail that you did not order suggests your Medicare number has been compromised. Unexpected phone calls from healthcare providers or collection agencies regarding services you do not recognize, or changes in your medical records that you did not authorize, also warrant investigation.

Safeguarding Your Medicare Number

Protecting your Medicare number requires vigilance and treating it with the same care as other sensitive financial identifiers. Treat your Medicare card like a credit card, keeping it in a secure place and only carrying it when necessary for medical appointments. Never share your Medicare number with unknown callers, unsolicited visitors, or individuals who approach you offering “free” services or products in exchange for your information. Legitimate Medicare representatives will not call you to ask for your number or other personal details.

Only provide your Medicare number to trusted healthcare providers, pharmacists, and authorized insurers or their licensed agents when receiving services or enrolling in plans. Before discarding any documents that contain your Medicare number or other personal health information, always shred them to prevent unauthorized access. Be wary of any offers that seem too good to be true, especially those promising free medical services, tests, or equipment in exchange for your Medicare details, as these are scams.

Regularly reviewing your Medicare Summary Notices (MSNs) and utilizing secure online portals provided by Medicare to access your information can help you monitor your account for any suspicious activity.

Actions to Take If Your Number Is Compromised

If you suspect or confirm that your Medicare number has been misused, taking immediate action is important to mitigate harm. First, contact Medicare directly to report suspected fraud. You can call 1-800-MEDICARE (1-800-633-4227) to report the fraudulent activity. For those with Medicare Advantage Plans or Medicare drug plans, contacting your specific plan is also necessary.

Report the incident to the Office of the Inspector General (OIG). The OIG investigates fraud, waste, and abuse. You can file a complaint with the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477) or submit a complaint online through their website. The OIG identifies and prosecutes healthcare fraud.

If you believe medical identity theft has occurred, file a police report with your local law enforcement agency. This creates an official record of the crime, useful for other reporting steps. Monitoring your credit reports for any unusual activity is also advised, as medical identity theft can precede broader financial identity theft. Finally, keep meticulous records of all communications, including dates, times, names, and reference numbers for any reports filed. This documentation is important throughout the resolution process.