Medicare fraud is rampant, and your clients are paying the price. As a Medicare agent, you can help by educating your clients on the red flags to watch for and tips on how to stay safe.
What Is Medicare Fraud?
Medicare fraud can take many forms, but it frequently involves someone using a Medicare beneficiary’s personal information to make fraudulent claims.
Common scams include:
- The Medicare Supply Scam. Fraudsters bill Medicare for unnecessary supplies. The scammer may tell the targeted Medicare enrollee that the supplies are free, or the scammer may simply use someone’s Medicare number without their knowledge.
- The Medicare Testing Scam. Fraudsters offer “free” testing, such as genetic testing or COVID-19 testing, and then bill Medicare.
- The Hospice Scam. Fraudsters steal Medicare numbers to enroll healthy beneficiaries in hospice care and bill Medicare for services that are never provided.
How Does Medicare Fraud Hurt Enrollees?
Medicare fraud can hurt enrollees in two distinct ways.
Indirectly, Medicare fraud leads to higher costs for everyone. A report from the Joint Economic Committee concluded that Medicare Advantage overpayments increased Part B premiums by $212 per enrollee in 2025. Combined, enrollees paid $13.4 billion in higher premiums as a result.
Directly, your clients may have trouble accessing their benefits if someone else has used them fraudulently. This is what has happened as a result of widespread hospice fraud, according to CalMatters:
- In one instance, a woman needed surgery for a shoulder injury but was otherwise healthy. Coverage was denied because Medicare records showed her as enrolled in hospice care. For six months, until she could get it straightened out, she had to continue paying her premiums but was unable to use her coverage.
- In another instance, a woman needed surgery after a serious fall, but coverage was denied because records showed she was currently enrolled in hospice care. She died two months later, without receiving the surgery she needed.
How Can Seniors Avoid Medicare Scams?
Guard your personal information. Scammers will use all sorts of tactics to try to convince people to hand over their personal information. They may pretend to be from CMS and say they need to verify your coverage or issue a new card, or they may say you owe money and threaten to cancel your benefits if you don’t comply. They also often “spoof” phone numbers to make it look like they’re calling from an official agency. If someone calls you unexpectedly and demands your information, just hang up.
Read your statements. Check your Medicare Summary Notice (for Original Medicare) or Explanation of Benefits (for Medicare Advantage and Medicare Part D). If you see any services or supplies that you need not receive, report the discrepancy immediately. Even if you are not being charged for the items or services, it’s important to get the issue straightened out as quickly as possible, before it interferes with your ability to receive legitimate benefits.
Be wary of free offers. Scammers often offer free incentives to trick Medicare enrollees into handing over their Medicare numbers and other personal information. For example, they may offer free braces or tests. Don’t fall for it. For Medicare coverage to apply, the service or supplies need to be medically necessary and ordered by your doctor, so someone calling random people to offer services and supplies is a scammer.
Report anything suspicious. For example, if you receive boxes of medical supplies you never ordered, you’re probably the victim of Medicare fraud. Report it immediately.
How to Report Medicare Fraud
If you suspect Medicare fraud, you can report it to CMS by calling 1-800-MEDICARE (1-800-633-4227), or you can report Medicare fraud online.
If you have a Medicare Advantage or Medicare Part D plan, notify the plan. You can also contact the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379).
When you call to report Medicare fraud, be ready to provide:
- Your name
- Your Medicare number
- The name of the provider you’re reporting, along with any other identifying information, or the service or item you’re reporting
- The amount that Medicare approved and paid
- The date on your Medicare Summary Notice, Explanation of Benefits, or claim
By helping your clients avoid Medicare fraud, you can protect them from losses while supporting a stronger Medicare system.
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