Medicare Fraud and Abuse: 6 Ways to Protect Yourself

  • Money
    Medicare fraud and abuse costs billions of dollars.
    No one knows exactly how much Medicare fraud and abuse cost U.S. taxpayers. Some estimates put the number at $60 billion dollars in overpayments to providers. A portion of that number may be honest billing mistakes. But Medicare fraud and abuse is a huge problem that costs everyone. There are many different fraud schemes, but they all come down to collecting money for illegitimate services. Medicare identity theft—when someone uses your Medicare identity to receive healthcare services—is also a huge problem.

  • woman pointing at financial record on table
    1. Check your statements.
    Although the paperwork can be overwhelming at times, it’s important to make sure your doctor, hospital, and other providers only bill for the services you received. You can do this by reviewing your Medicare claims and summary notices. Look for services you don’t recognize. Examples include billing for home health services if you weren’t confined to your home or can still drive a car, and billing for medical equipment for someone in a nursing home. Use a calendar to mark your appointments, tests, or hospital stays. Then, you can compare your statements to your calendar to see if they match.

  • young medical assistant showing senior woman information on tablet
    2. Know what services you are agreeing to receive.
    Ask your provider what the service will cost and how much you have to pay before you agree to it. Never sign blank insurance claim forms or give blanket authorization to a medical provider to bill for services. And don’t let anyone other than your doctor or medical provider recommend a service. These are the only people who should have access to your medical records as well. You can do your part by not requesting services or medicines you don’t need.

  • Doctor showing patient digital tablet in hospital room
    3. Watch for unnecessary tests.
    Just because the test is covered by Medicare doesn’t mean you need it. You can learn more about potentially unnecessary tests at Choosing Wisely. You should be suspicious of someone telling you that the more tests you get, the cheaper the tests. Or, someone using pressure or scare tactics to sell you expensive medical services or diagnostic tests. Likewise, anyone who gives “free” screenings or tests in non-healthcare settings like shopping malls should not ask for information so they can bill for the test.

  • credit card and identity theft concept with lock
    4. Protect your Medicare number.
    Your Medicare number is part of your identity (as well as your Social Security number). If someone gets ahold of it, they can bill Medicare for fraudulent services. Having your Medicare number allows them to use your identity to get medical services or buy drugs as well. They can also steal your identity in other financial arenas. So only give it to doctors, other healthcare providers, Medicare-approved plans, your insurer, and others you trust who work with Medicare.

  • Young office worker on the phone
    5. Be aware of scams.
    Medicare will never contact you by phone, email, or in person for personal information, unless you have given them permission. This includes asking for your Medicare number. Likewise, Medicare can’t enroll you over the phone unless you asked them to do it. Medicare will never come to your home, try to sell you anything, or give you money, gifts, or free medical care. Medicare will only contact you by phone if you have called them and left a message. A Medicare Advantage or Part D drug plan will only call you if you are already a member of the plan. If someone calls asking for your Medicare number, hang up and report it.

  • man talking on phone in office
    6. Report suspicious activity to the Medicare fraud hotline.
    If you notice a charge or a claim you think is incorrect, contact your provider first. It may be a billing error and not outright fraud. If you don’t know the provider or if your provider doesn’t respond to your inquiries, it could be time to file a Medicare fraud report. You should also report any potential fraud by con artists using the phone, email, or in-person contacts. To report suspected fraud or abuse, call the Center for Medicare Services (CMS) Hotline at 1-800-MEDICARE (800-633-4227). You may even get a reward for helping fight fraud!

Medicare Fraud and Abuse: 6 Ways to Protect Yourself

About The Author

Sarah Lewis is a pharmacist and a medical writer with over 25 years of experience in various areas of pharmacy practice. Sarah holds a Bachelor of Science in Pharmacy degree from West Virginia University and a Doctor of Pharmacy degree from Massachusetts College of Pharmacy. She completed Pharmacy Practice Residency training at the University of Pittsburgh/VA Pittsburgh Healthcare System. 
  1. Challenge of Health Care Fraud. National Health Care Anti-Fraud Association. https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx 
  2. Fraud And Billing Mistakes Cost Medicare — And Taxpayers — Tens Of Billions Last Year. Kaiser Health News. https://khn.org/news/fraud-and-billing-mistakes-cost-medicare-and-taxpayers-tens-of-billions-last-year/ 
  3. Help Fight Medicare Fraud. Centers for Medicare and Medicaid Services. https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud 
  4. How to Report Medicare Fraud. Centers for Medicare and Medicaid Services. https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/how-report-medicare-fraud 
  5. How to Spot Medicare Fraud. Centers for Medicare and Medicaid Services. https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/how-spot-medicare-fraud 
  6. Identity Theft: Protect Yourself. Centers for Medicare and Medicaid Services. https://www.medicare.gov/forms-help-resources/identity-theft-protect-yourself 
  7. Medical Identity Theft and Medicare Fraud. https://oig.hhs.gov/fraud/medical-id-theft/HHS_OIG_Medical_Identity_Theft_plain_text.pdf 
  8. Medicare Fraud and Abuse: Prevent, Detect, Report. Centers for Medicare and Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf 
  9. Medicare Under Assault From Fraudsters. AARP. https://www.aarp.org/money/scams-fraud/info-2018/medicare-scams-fraud-identity-theft.html 
  10. Tips to Prevent Fraud. Centers for Medicare and Medicaid Services. https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/tips-prevent-fraud 


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