Understand the warning signs of Medicare fraud, how to protect your personal information, and the steps to take if you suspect suspicious activity.
Medicare fraud is a serious and growing issue that affects not only the government but also individual beneficiaries. From billing for services that never happened to identity theft, Medicare fraud takes different forms and can be carried out by providers, suppliers, third-party scammers, or even patients.
Understanding what Medicare fraud looks like is an important step in protecting yourself and the federal system.
What is Medicare Fraud?
Medicare fraud typically involves making false claims or misrepresenting information with the intent to manipulate for financial or personal gain via a Medicare beneficiary or the Medicare program.
For example, someone may bill for more complex medical services that are inaccurate compared to the actual services provided, also known as upcoding. In some cases, someone may submit billing for services or equipment that were never administered at all, falsifying records.
Intentionally ordering medically unnecessary services can also be considered Medicare fraud, as well as rewarding someone for referrals within Federal health programs. Identity theft can also be common among Medicare beneficiaries.
Fortunately, individuals can better protect their information by following safety guidelines, including these 4 tips to protect themselves from Medicare fraud.
How To Protect Yourself from Medicare Fraud
Although Medicare fraud can be daunting, there are ways to protect yourself and decrease the risk of fraudulent activity.
Safeguard Your Medicare Information
The biggest factor in protecting yourself is to keep your Medicare information secure. Do not share your Medicare number with anyone or any organization unless absolutely necessary. For example, if you’re completing an application for a Medigap, Part D, or Medicare Advantage policy through an insurance carrier, you will need your Medicare number. Otherwise, be careful of who you share your Medicare information with.
Be Vigilant with Medicare Services and Billing
Another way to protect yourself is to keep track of doctor’s visits and medical services. Some people keep a healthcare journal or calendar to organize this information.
You’ll also want to review your Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs), both of which include information on the services you’ve had and what you can expect to pay. Doing so will help you monitor bills and ensure they match the actual services you’ve had.
Watch Out for Red Flags
There are several red flags to watch for when trying to keep your Medicare information safe. First, if anyone is offering something “free,” be cautious. Often, the offer is misleading or only applies to specific people. Also, be wary of unsolicited calls or visits, especially if you feel pressured to sign up for something.
Another thing to watch for is bills for services you’ve never received, duplicate charges, or incorrect provider information. If you don’t recognize something, it’s always good to verify the information to be safe before moving forward.
Lastly, be aware that Medicare rarely calls people directly. If someone contacts you claiming to be Medicare, be careful. It’s always best to keep your information to yourself and contact Medicare directly to verify the communication you received.
How Medicare Fraud Affects You
Medicare fraud can affect you in several ways. First, it can negatively impact your finances if you pay more than you should have or if a malicious group or individual gains access to your financial information through a data leak or something similar.
Additionally, Medicare fraud can damage your medical records, affecting your medical care. Fortunately, procedures and federal laws exist to help mend situations like this.
Medicare fraud can also influence the Medicare program as a whole. In fact, according to the U.S. Department of Health and Human Services, there were $2.75 billion in false billings to federal programs in 2024. 1
How to Report Medicare Fraud
If you encounter Medicare fraud or are suspicious of certain activities, there are ways to report this behavior. To submit an official complaint to the government, you can go online to the Office of Inspector General as part of the U.S. Department of Health and Human Services. There, you can learn about the different types of fraud you can report and submit an online complaint.
Summary
Medicare fraud can have various consequences, including financial loss, false medical records, and increased healthcare costs. While individuals or organized groups may commit fraudulent activity, beneficiaries can take steps to protect themselves.
By safeguarding Medicare information, tracking medical services, and staying alert to suspicious activity, individuals can reduce their risk of fraud. If something feels off, reporting it to the appropriate authorities, such as the Office of Inspector General, can help stop fraud and protect others.
1https://oig.hhs.gov/newsroom/media-materials/2024-nationwide-health-care-fraud-enforcement-action/