5 ways to protect yourself from Medicare fraud

Jul 20, 2022, 4:00 AM | Updated: 4:20 am

Medicare fraud is big business, and like most businesses, it has adapted to the new environment of the COVID-19 pandemic.

“The public health emergency created an opportunity for fraudsters to modify and repurpose existing schemes,” a spokesperson for the Centers for Medicare & Medicaid Services, or CMS, said in an email. CMS has seen bad actors take advantage of wider demand for telehealth, COVID-19 testing and vaccines as avenues for identity theft and fraudulent billing.

The Department of Health and Human Services’ Office of Inspector General, or HHS-OIG, investigates fraud, waste and abuse in federal health care programs, including Medicare. Nearly 9,000 calls came into its fraud hotline each month, on average, from April through September 2021, according to HHS-OIG’s Spring 2022 report to Congress.

Calling a fraud hotline is one of several actions Medicare beneficiaries can take to protect themselves. Here are five tips to help you avoid, detect and report Medicare fraud.


In the wrong hands, your Medicare number could be used to steal your identity or submit fraudulent medical bills.

“Our top tip is to guard your Medicare number just like your Social Security (number) and credit cards,” the CMS spokesperson said. “You should only share your Medicare number with trusted health care providers or verified COVID-19 vaccine administrators.”

Unexpected callers or visitors who ask for your Medicare information are suspicious, especially if they claim to work for Medicare. According to CMS, Medicare will never visit you at home, and a Medicare representative would ask for your Medicare number by phone only if you’ve given permission in advance.


Fraudsters might try to get your information by offering you something for free in exchange. If you’re asked to provide your medical or financial information and promised a supposedly free gift or service, “that’s something to question, or at least run by a medical professional that you trust,” says Isaac Bledsoe, an HHS-OIG criminal investigator.

Common examples of free offers might include COVID-19 tests, genetic testing services, or durable medical equipment like walkers or braces.


Some schemes involve billing for expensive services that you might not need. For example, unscrupulous COVID-19 testing sites might add on unnecessary respiratory pathogen panels that can cost upwards of $500 . That’s according to a January 2022 white paper by the Healthcare Fraud Prevention Partnership, a public-private anti-fraud group.

If you’re not certain, check with a trusted health care provider to confirm whether a service is necessary and what it might cost.


Medicare sends statements to explain what you were billed for, how much Medicare approved and paid for services, and the maximum amount you may owe to health care providers. Watch for any unexpected items or charges on these statements.

To help you keep track of everything, you can request a free “My Health Care Tracker ” from your state’s Senior Medicare Patrol, or SMP. SMPs are grant-funded projects that provide resources and counseling to help counter Medicare fraud, errors and abuse.

My Health Care Tracker documents include sheets to record information about your health care, instructions for how to compare your statements to what was billed, and contact information for agencies that can help with issues like errors or fraud.


If you’re concerned about potential Medicare fraud, there are free resources you can call for help. Don’t hesitate to call even if you’re not certain. Bledsoe encourages beneficiaries to report “anything that you may think is potentially harmful or potentially fraudulent.”

There are two main government hotlines:

— Call CMS’ Medicare help line at 800-MEDICARE (800-633-4227) .

— Call HHS-OIG’s fraud, waste and abuse hotline at 800-HHS-TIPS (800-447-8477) or submit an online complaint at oig.hhs.gov/fraud/report-fraud .

You can also contact your Senior Medicare Patrol for help, and they can refer your issue to the appropriate authorities . Visit smpresource.org for contact information.

Whoever you call first can help, and you don’t need to contact separate hotlines. Bledsoe says that different agencies have made coordination a priority, so “there’s no need to call nine different places to report it nine different ways.”

“We can look into (issues) immediately and give sort of a quick answer of ‘yes, this is something that is not good,'” Bledsoe says. “We can put your Medicare number on a ‘potential vulnerable’ list to look out for any future billing that you may not have asked for, and we can help you going forward.”


This article was provided to The Associated Press by the personal finance website NerdWallet. Alex Rosenberg is a writer at NerdWallet. Email: arosenberg@nerdwallet.com.


NerdWallet: What is Medicare, and what does it cover? https://bit.ly/nerdwallet-what-is-medicare-and-what-does-it-cover

HHS-OIG Semiannual Report to Congress https://oig.hhs.gov/reports-and-publications/archives/semiannual/2022/2022-spring-sar.pdf

Senior Medicare Patrol https://www.smpresource.org/

Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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5 ways to protect yourself from Medicare fraud