5 methods to guard your self from Medicare fraud

Medicare fraud is massive enterprise, and like most companies, it has tailored to the brand new setting 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, stated in an e mail. CMS has seen unhealthy actors make the most of wider demand for telehealth, COVID-19 testing and vaccines as avenues for identification 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 well being care applications, together with Medicare. Nearly 9,000 calls got here into its fraud hotline every month, on common, from April by means of September 2021, in line with HHS-OIG’s Spring 2022 report to Congress.

Calling a fraud hotline is one among a number of actions Medicare beneficiaries can take to guard themselves. Here are 5 tips that will help you keep away from, detect and report Medicare fraud.


In the unsuitable fingers, your Medicare quantity may very well be used to steal your identification or submit fraudulent medical payments.

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

Unexpected callers or guests who ask in your Medicare info are suspicious, particularly in the event that they declare to work for Medicare. According to CMS, Medicare won’t ever go to you at house, and a Medicare consultant would ask in your Medicare quantity by cellphone provided that you’ve given permission upfront.


Fraudsters would possibly attempt to get your info by providing you one thing totally free in alternate. If you’re requested to supply your medical or monetary info and promised a supposedly free present or service, “that’s something to question, or at least run by a medical professional that you trust,” says Isaac Bledsoe, an HHS-OIG legal investigator.

Common examples of free gives would possibly embody COVID-19 exams, genetic testing providers, or sturdy medical gear like walkers or braces.


Some schemes contain billing for costly providers that you simply may not want. For instance, unscrupulous COVID-19 testing websites would possibly add on pointless respiratory pathogen panels that may value upwards of $500 . That’s in line with a January 2022 white paper by the Healthcare Fraud Prevention Partnership, a public-private anti-fraud group.

If you’re not sure, verify with a trusted well being care supplier to verify whether or not a service is critical and what it may cost a little.


Medicare sends statements to clarify what you have been billed for, how a lot Medicare permitted and paid for providers, and the utmost quantity it’s possible you’ll owe to well being care suppliers. Watch for any sudden gadgets or fees on these statements.

To allow you to preserve observe of every thing, you may request a free “My Health Care Tracker ” out of your state’s Senior Medicare Patrol, or SMP. SMPs are grant-funded initiatives that present sources and counseling to assist counter Medicare fraud, errors and abuse.

My Health Care Tracker paperwork embody sheets to report details about your well being care, directions for find out how to evaluate your statements to what was billed, and phone info for businesses that may assist with points like errors or fraud.


If you’re involved about potential Medicare fraud, there are free sources you may name for assist. Don’t hesitate to name even in the event you’re not sure. Bledsoe encourages beneficiaries to report “anything that you may think is potentially harmful or potentially fraudulent.”

There are two principal authorities hotlines:

— Call CMS’ Medicare assist 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 internet criticism at oig.hhs.gov/fraud/report-fraud .

You can even contact your Senior Medicare Patrol for assist, and so they can refer your situation to the suitable authorities . Visit smpresource.org for contact info.

Whoever you name first may help, and also you don’t must contact separate hotlines. Bledsoe says that completely different businesses have made coordination a precedence, 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 offered to The Associated Press by the private finance web site NerdWallet. Alex Rosenberg is a author at NerdWallet. Email: arosenberg@nerdwallet.com.


NerdWallet: What is Medicare, and what does it cowl? 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/

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