In early 2023, a group of Michigan residents were charged with submitting fake home health care claims in a shocking Medicare scam totaling $61.5 million. In another scheme, three men were accused of filing more than $107 million in fraudulent genetic testing claims to Medicare.

What is a Medicare scam?

“With a Medicare scam, criminals pretending to be from Medicare or another known organization try to trick a beneficiary into sharing their Medicare or Social Security number,” said Brandy Bauer, former Director of NCOA's MIPPA Resource Center. “Most often, this information is used to commit identity theft. Crooks submit bogus Medicare claims in the beneficiary’s name to obtain health care services, supplies, or even prescription drugs.”

Medicare scammers often use the phone to find targets, but they may also reach out via email, text messages, and postal mail. Fraudulent activity tends to ramp up during the yearly Medicare Open Enrollment Period (Oct. 15 - Dec. 7), when beneficiaries are encouraged to review their health care coverage and make any necessary changes.

Estimates show that Medicare and Medicaid fraud costs the government and taxpayers more than $100 billion each year—but the real figures are likely much higher. Medicare scams affect older adults who rely on the program, too. Unauthorized treatments can max out an enrollee’s benefits faster and cost them copayments for services they didn't receive. Fake treatments on a person’s Medicare records can also make it difficult for providers to understand that individual’s true medical history.

What are the warning signs of a Medicare scam?

Medicare scammers can sound very professional over the phone. They often use technology to create convincing websites, emails, and print materials that appear to be from a trustworthy organization. That’s why it’s essential to learn all you can about Medicare scams. Staying vigilant and knowing what red flags to look for can help you or your loved one stay safe.

Telltale warning signs of a Medicare scam

1. Promises of free items or services: Be suspicious of any offers involving no-cost medical supplies, medical care, or prescription medications. Many scammers will offer older adults valuable medical equipment, persuade them to share their Medicare number, and then use that information to file high-cost Medicare claims in the beneficiary’s name. Also, beware of offers for free genetic testing or screenings that were not ordered by your physician. This is a known Medicare scam.
2. Pressure to switch your Medicare plan: A scammer, often claiming to be from Medicare, may say you're “pre-approved” for a new health care plan or drug plan with lower premiums or better benefits. They may tell you there’s a fee to enroll in this new plan.
3. Notices to renew or upgrade your Medicare card: A fraudster may call and say you need to activate, renew, or upgrade your Medicare card. They may ask for your Medicare number to “verify” your account, or they may request that you pay a processing fee.
4. Threats to cancel your coverage: You may receive a call stating there’s a problem with your Medicare account, such as fraudulent activity. The caller says your benefits will be canceled if you don’t immediately verify your personal information or join a new plan.
5. Claims you’re eligible for a refund: Another common Medicare scam tactic is telling older adults they qualify for a refund due to changes in their plan. The scammer may ask for your Medicare number—and even your bank account details.

How can I protect myself from Medicare scams?

Scammers are everywhere, and Medicare scams can happen to anyone. The tips below can help you keep your personal information safe.

• Avoid sharing your Medicare number with people who contact you out of the blue: Do not provide your Medicare card, Medicare Number, Social Security card, or Social Security Number to anyone but your doctor, pharmacy, or people who work with Medicare to assist beneficiaries. These numbers should be protected just like you would protect your credit card, debit card, or bank account information. It’s important to know Medicare will not call you unless you’ve specifically asked for help. And if they do call you in response to a request, they will not need your information since they’ll already have it on file.
  
  Does your caller ID show a legitimate-looking phone number? Don’t be fooled. Scammers can spoof their number to make it look like the call is coming from a government agency or other known organization. Also, don’t be surprised if the caller has some basic information about you. With the internet, those details are easy to find today. If someone unfamiliar calls asking you for personal details, simply hang up.
• Do not click on suspicious links: Criminals create fake email addresses to make it appear messages are coming directly from Medicare. These emails may send you to a website that looks authentic. Do not respond to unexpected emails or text messages or click on any links they contain—even if the communication looks real.
  
  If you need to update your information, log in to your Medicare account at Medicare.gov, call 1-800-MEDICARE (1-800-633-4227), or talk to a trusted advisor.
• Do not be afraid of threats to terminate benefits: If you qualify for Medicare, your benefits will not be taken away for reasons like not signing up for a certain plan.
• Do not speak to anyone who tries to persuade you to choose a certain plan: Ignore claims that any policy is “preferred by Medicare,” since Medicare does not endorse a specific plan.
• Destroy your old Medicare card: Some scammers may claim you need to return your old card; however, this is not true. Once you receive a new Medicare card, your old one is not needed. Destroy it with scissors or a shredder and start using the replacement immediately.
• Protect your medical records: Do not allow anyone but your doctor or other health care providers to review your personal medical information.
• Do not accept unauthorized genetic testing kits: If you receive a genetic testing kit in the mail that was not ordered by your doctor, refuse the delivery outright or return it to the sender.

How do I report Medicare scams?

If you believe you’ve been involved in a Medicare scam, take action by reporting it:

• Call Medicare directly at 1-800-MEDICARE (800-633-4227).
• Contact the Senior Medicare Patrol Resource Center by calling 1-877-808-2468 or use their online contact form.
• Submit a report online to the Federal Trade Commission (FTC).

"It’s important to always be on the lookout for something fishy," Medicare expert Ari Parker recently told The Street.  

Keep in mind that adults of all ages can be affected by a scam and that reporting your experience will only help others,” Parker said.

How do I get unbiased Medicare advice?

Want to be confident in the Medicare enrollment choices you make? NCOA has identified trustworthy brokers who meet our strict Medicare Standards of Excellence (SOE). Having gone through a rigorous SOE training and certification process, these certified advisors are highly qualified to help you review your options and choose a plan that works for you. Best of all, talking to them costs you absolutely nothing.