Medicare Scams and Fraud: How to Protect Yourself

Why Medicare Fraud Is a Growing Threat

Medicare fraud costs taxpayers tens of billions of dollars every year and directly harms the beneficiaries it targets. The Department of Health and Human Services Office of Inspector General (HHS OIG) estimates that improper payments in Medicare exceeded $46 billion in fiscal year 2025 alone. Scammers view Medicare beneficiaries as high-value targets because Medicare numbers are linked to both healthcare benefits and personal identity information that can be resold on the black market.

The consequences are not abstract. If someone steals your Medicare number and uses it to bill for services you never received, it creates false entries in your medical record. Those false records can lead to incorrect treatments, denied claims for care you actually need, and hours of frustration trying to correct the damage. In the worst cases, victims have been prescribed the wrong medications or denied coverage because their records showed conditions they never had.

This guide covers the most common Medicare scams, the red flags that reveal them, exactly how to report fraud, and the steps you can take right now to protect yourself.

The Most Common Medicare Scams

Scammers use a wide range of tactics, but most Medicare fraud falls into a handful of categories that every beneficiary should recognize.

Fake Enrollment and Verification Calls

This is the single most common Medicare scam. You receive an unsolicited phone call from someone claiming to be from Medicare, Social Security, or a health insurance company. The caller says they need to "verify" your Medicare number, update your records, or send you a new Medicare card. They may tell you that your benefits are about to be canceled if you do not confirm your information immediately. The goal is always the same: to get your Medicare Beneficiary Identifier (MBI), your Social Security number, or your bank account information.

Medicare will never call you unsolicited to ask for your Medicare number or personal information. If you receive a call like this, hang up immediately. If you need to contact Medicare, call 1-800-MEDICARE (1-800-633-4227) directly or log into your account at Medicare.gov.

Medicare Identity Theft

Medicare identity theft occurs when someone obtains your MBI and uses it to submit fraudulent claims. This can happen through phishing calls, stolen mail, data breaches, or even dishonest healthcare workers. Once a scammer has your number, they can bill Medicare for doctor visits, tests, and medical equipment you never received. The FTC reports that medical identity theft is one of the fastest-growing categories of identity fraud, and it is significantly harder to detect and resolve than credit card theft because medical bills often take months to appear on your Medicare Summary Notices.

Durable Medical Equipment (DME) Scams

DME fraud is one of the most profitable schemes in Medicare. Scammers set up fake medical supply companies or partner with corrupt providers to bill Medicare for wheelchairs, back braces, knee braces, CPAP machines, and other equipment that beneficiaries never ordered, never received, or never needed. In a typical scheme, a telemarketer cold-calls beneficiaries and offers a "free" knee brace or back support. If the beneficiary provides their Medicare number, the scammer bills Medicare thousands of dollars for equipment that costs a fraction of that amount — or that is never shipped at all.

The HHS OIG Medicare Fraud Strike Force has prosecuted hundreds of DME fraud cases. In one of the largest operations, a 2024 enforcement action resulted in charges against 193 defendants for approximately $2.75 billion in alleged fraud, with DME schemes accounting for a significant portion of the total. If anyone offers you free medical equipment and asks for your Medicare number, it is almost certainly a scam.

Phantom Billing and Upcoding

Phantom billing happens when a provider bills Medicare for services that were never provided. Upcoding is when a provider bills for a more expensive service than what was actually performed — for example, charging for a comprehensive office visit when only a brief follow-up occurred, or billing for a complex surgical procedure when a simpler one was done. Both are forms of fraud that drive up costs for the entire Medicare system and can create inaccurate entries in your medical record.

This is why reviewing your Medicare Summary Notices (MSNs) is critical. Your MSN arrives every three months and lists every service billed to Medicare on your behalf. If you see a charge for a visit you never made, a test you never had, or a provider you have never seen, it may be phantom billing — and you should report it immediately.

Fake Plan Switching Scams

During Medicare enrollment periods, scam activity surges. Fraudsters pose as licensed insurance agents and pressure beneficiaries into switching to a different Medicare Advantage plan or Part D drug plan — often one that pays the scammer a higher commission but does not cover the beneficiary's doctors or medications. Some use door-to-door visits, others use robocalls, and some set up fake enrollment websites that look official. Once a beneficiary is enrolled in the wrong plan, they may not realize the damage until they try to see their doctor or fill a prescription and discover they have no coverage.

Legitimate Medicare agents are prohibited from making unsolicited calls, going door-to-door without an appointment, or using high-pressure tactics. If someone shows up at your door unannounced claiming to be a Medicare representative, do not let them in and do not share any personal information.

Genetic Testing and Lab Scams

In recent years, genetic testing scams have become increasingly prevalent. Scammers set up booths at health fairs, community centers, or senior events and offer "free" genetic or DNA testing kits. They tell beneficiaries the test can detect cancer risk or other health conditions at no cost. In reality, the scammer collects the beneficiary's Medicare number and bills Medicare thousands of dollars for medically unnecessary tests. The results are often meaningless or never delivered. The OIG identified genetic testing fraud as a top enforcement priority, resulting in multiple nationwide takedowns involving hundreds of millions of dollars in false claims.

Red Flags That Signal a Medicare Scam

Knowing the warning signs is your first line of defense. If any of the following happen, treat it as a potential scam:

• Unsolicited contact. Someone calls, emails, texts, or shows up at your door claiming to be from Medicare or a Medicare-approved plan without you initiating the contact.
• Request for your Medicare number. Medicare already has your number. Legitimate representatives will never call to ask you to confirm it.
• Urgency and threats. Claims that your benefits will be canceled, your card will be deactivated, or you will face penalties unless you act immediately. Medicare does not operate this way.
• Offers of free equipment or services. Nothing Medicare-covered is truly "free" in the sense scammers describe. If someone offers you a free brace, genetic test, or wellness kit in exchange for your Medicare number, walk away.
• Requests for payment by gift card, wire transfer, or cryptocurrency. Medicare never asks for payment in these forms. Any such request is a scam, period.
• Bills for services you did not receive. Check your Medicare Summary Notices carefully. If you see charges for appointments, tests, or equipment you do not recognize, someone may be billing fraudulently under your number.
• Pressure to switch plans. A caller insists you must change your Medicare plan today or you will lose coverage. Legitimate enrollment decisions never require immediate action over the phone with a stranger.

What Medicare Will and Will Not Call You About

Understanding what legitimate Medicare communication looks like makes it much easier to spot fakes. Here is the reality:

Medicare WILL:

• Send you a Medicare card automatically when you first enroll, with your MBI printed on it
• Mail you Medicare Summary Notices every three months showing services billed on your behalf
• Call you back if you have already contacted Medicare and requested a callback
• Send you the Medicare & You handbook each fall before open enrollment

Medicare will NEVER:

• Call you to ask for your Medicare number, Social Security number, or bank information
• Threaten to cancel your benefits if you do not provide personal information
• Visit your home uninvited to sell you a plan or collect information
• Ask for payment by gift card, wire transfer, or cryptocurrency
• Pressure you to enroll in a specific plan over the phone or at your door

Telling Real Medicare Marketing from Scams

Legitimate Medicare Advantage and Part D plans do market to beneficiaries, and it can be confusing to tell real outreach from scam activity. Here is how to distinguish between the two.

Legitimate agents and plans:

• Only contact you if you have given prior permission (filled out a form, called a number, or requested information)
• Provide their name, the plan name, and a callback number you can verify
• Give you time to review plan details and never pressure you into an immediate decision
• Can show you their state insurance license number if asked
• Never ask for payment or your bank details to enroll you in a Medicare plan

Scam operators:

• Call or visit without invitation, often using spoofed caller IDs that look like government numbers
• Refuse to provide verifiable credentials or claim they do not need a license
• Create false urgency — telling you that you must decide right now or lose your benefits
• Offer gifts, cash, or free meals in exchange for enrollment (a CMS marketing violation)
• Ask you to share your Medicare number before explaining the plan they represent

How to Protect Your Medicare Number

Your Medicare Beneficiary Identifier is as sensitive as your Social Security number. In 2018, Medicare replaced Social Security-based numbers with unique MBIs specifically to reduce identity theft. But your MBI can still be exploited if it falls into the wrong hands. Here is how to protect it.

• Guard your card. Do not carry your Medicare card in your wallet unless you are going to a medical appointment. Keep it in a secure location at home. If your card is lost or stolen, request a replacement immediately by calling 1-800-MEDICARE or visiting Medicare.gov.
• Never share your number with strangers. Only give your MBI to your doctor, hospital, pharmacy, or health insurer when you are receiving care. Never provide it to someone who contacts you unsolicited.
• Review your Medicare Summary Notices. Check your MSN every quarter. Compare the listed services to your actual appointments. Flag anything you do not recognize. You can also check claims in real time by creating an account at Medicare.gov.
• Shred documents. Shred any documents containing your Medicare number, MBI, or personal health information before discarding them. This includes old MSNs, Explanation of Benefits statements, and prescription paperwork.
• Be skeptical of "free" offers. If someone offers you free medical equipment, genetic tests, or other services in exchange for your Medicare information, it is almost always a scam. Legitimate Medicare-covered services are ordered by your doctor, not offered by strangers.
• Use a secure mailbox. Medicare correspondence arrives by mail. If possible, use a locked mailbox or a P.O. box to prevent mail theft. Collect your mail promptly and do not leave it sitting in an unsecured box.

How to Report Medicare Fraud

If you suspect fraud, reporting it quickly limits the damage and helps protect other beneficiaries. There are several channels for reporting, and you should use whichever is most appropriate for your situation.

• 1-800-MEDICARE (1-800-633-4227). This is Medicare's primary fraud hotline. Call if you see suspicious charges on your MSN, if you believe your Medicare number has been compromised, or if you suspect a provider is billing fraudulently. TTY users can call 1-877-486-2048. Available 24 hours a day, 7 days a week.
• HHS Office of Inspector General (OIG). Report fraud online at oig.hhs.gov/fraud/report-fraud or call the OIG hotline at 1-800-HHS-TIPS (1-800-447-8477). The OIG investigates large-scale fraud schemes and works with law enforcement to prosecute offenders.
• Senior Medicare Patrol (SMP). Every state has a Senior Medicare Patrol program staffed by trained volunteers who help beneficiaries detect and report fraud. SMP counselors can review your MSNs with you, help you understand suspicious charges, and guide you through the reporting process. Find your local SMP at smpresource.org.
• Federal Trade Commission (FTC). If you have experienced identity theft related to Medicare, report it at IdentityTheft.gov. The FTC will create a personalized recovery plan and help you dispute fraudulent charges. You can also report scam calls and deceptive practices at ReportFraud.ftc.gov.
• Your Medicare Advantage or Part D plan. If you are enrolled in a Medicare Advantage or Part D plan, contact your plan directly using the number on your member ID card. Plans have their own fraud investigation units and are required to take reports seriously.

When you report, have the following information ready: your Medicare number, the date of the suspicious activity, the name of the provider or caller (if known), and a description of what happened. Keep copies of any related documents, including MSNs, bills, and notes about phone calls.

Recent Medicare Fraud Enforcement Actions

Federal enforcement of Medicare fraud has intensified significantly. Understanding the scale of recent cases shows why personal vigilance matters.

• 2024 National Health Care Fraud Enforcement Action. The DOJ charged 193 defendants across the country for approximately $2.75 billion in alleged healthcare fraud. The cases spanned telemedicine fraud, DME scams, opioid distribution schemes, and kickback arrangements. This was one of the largest coordinated takedowns in the history of the Medicare Fraud Strike Force.
• Telemedicine fraud crackdown. Following the expansion of telehealth during the pandemic, the OIG identified widespread abuse where fraudulent telemedicine companies conducted brief or sham consultations to justify orders for expensive DME and genetic tests. Multiple rings were dismantled, with individual cases involving hundreds of millions of dollars in false claims.
• Genetic testing scheme prosecutions. Over 50 defendants were charged in connection with a nationwide genetic testing fraud scheme that billed Medicare over $2.1 billion. Recruiters at health fairs collected cheek swabs and Medicare numbers, then submitted claims for expensive cancer genetic tests that were medically unnecessary and whose results were never reviewed by treating physicians.
• COVID-related fraud. Fraudsters billed Medicare for COVID tests never administered, used pandemic-related rule relaxations to submit false telehealth claims, and impersonated public health officials to harvest Medicare numbers. The OIG recovered hundreds of millions in COVID-related healthcare fraud between 2021 and 2025.

These cases demonstrate that Medicare fraud operates at industrial scale. The more informed you are, the harder it is for scammers to succeed.

What to Do If You Are a Victim of Medicare Fraud

If you believe your Medicare number has been stolen or used fraudulently, take these steps immediately:

1. Call 1-800-MEDICARE. Report the suspected fraud and ask them to review the charges in question. They can flag your account and investigate.
2. Review your Medicare Summary Notices. Go through your recent MSNs or log into Medicare.gov to check for unfamiliar claims. Note the dates, providers, and service descriptions for anything suspicious.
3. Contact the OIG. File a formal complaint at oig.hhs.gov/fraud/report-fraud or call 1-800-HHS-TIPS. This creates an official record and may trigger an investigation.
4. Report identity theft to the FTC. Visit IdentityTheft.gov to create a recovery plan. The FTC will help you take steps to secure your personal information and dispute fraudulent activity.
5. Monitor your credit. If your Social Security number was also compromised, place a fraud alert on your credit reports with Equifax, Experian, and TransUnion. Consider a credit freeze for maximum protection.
6. Contact your local SMP. A Senior Medicare Patrol counselor can walk you through the entire process, help you understand what happened, and assist with correcting your medical records.

Understanding the 4 Parts of Medicare and Fraud Risk

Each part of Medicare is susceptible to different types of fraud. If you are not yet familiar with how Medicare is structured, our guide to the 4 parts of Medicare explains Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage) in detail.

• Part A fraud: Billing for unnecessary hospital admissions, phantom home health visits, and inflated charges for skilled nursing facility stays.
• Part B fraud: Upcoding office visits, billing for tests never performed, and DME scams involving braces, wheelchairs, and medical supplies.
• Part C fraud: Upcoding patient risk scores to increase government payments to Medicare Advantage plans, enrolling beneficiaries without their consent, and marketing violations.
• Part D fraud: Billing for prescriptions that were never dispensed, switching patients to more expensive brand-name medications to increase reimbursement, and pharmacy kickback schemes.

How to Apply for Medicare Safely

If you are approaching 65 or otherwise becoming eligible, it is important to apply for Medicare through official channels only. The three legitimate ways to enroll are: visiting ssa.gov online, calling Social Security at 1-800-772-1213, or visiting your local Social Security office in person. Never enroll through a link sent to you by an unsolicited email, text message, or phone call. Scammers frequently set up fake enrollment websites that mimic the look of official government sites. Always verify you are on a .gov domain before entering any personal information.

Frequently Asked Questions

Will Medicare ever call me? Medicare may call you if you have called them first and requested a callback, or if you are part of a Medicare survey. They will never call you out of the blue to ask for your Medicare number, Social Security number, or bank information. If you receive an unexpected call claiming to be from Medicare, hang up and call 1-800-MEDICARE directly to verify.

What should I do if I gave my Medicare number to a scammer? Call 1-800-MEDICARE immediately to report the incident. Ask them to place a note on your account. Then monitor your Medicare Summary Notices and Medicare.gov account closely for any unfamiliar claims. File an identity theft report at IdentityTheft.gov and contact your local Senior Medicare Patrol for additional help. If you believe your Social Security number was also compromised, place fraud alerts on your credit reports.

Can I get a new Medicare number if mine is stolen? Yes. If your MBI has been compromised, you can request a new Medicare number by calling 1-800-MEDICARE. They will issue a new MBI and send you a replacement card. The process typically takes a few weeks. In the meantime, you can still receive care using your existing number — your coverage is not interrupted.

How do I check for suspicious claims on my Medicare account? Log into your account at Medicare.gov and check the claims section. You can see every service billed to Medicare under your number. You can also review your Medicare Summary Notices, which are mailed every three months. Look for services you did not receive, providers you have never visited, dates when you were not at a medical facility, and medical equipment you did not order.

Is it safe to carry my Medicare card in my wallet? It is generally recommended that you do not carry your Medicare card with you daily. Keep it in a secure place at home and only bring it when you have a medical appointment. If your wallet is lost or stolen with your Medicare card inside, it exposes your MBI to potential thieves. Some people take a photo of their card on their phone as a backup, but make sure your phone is protected with a strong passcode or biometric lock.

What is the Senior Medicare Patrol and how can they help? The Senior Medicare Patrol (SMP) is a national program funded by the federal government that trains volunteers to help Medicare and Medicaid beneficiaries prevent, detect, and report healthcare fraud. Every state has an SMP. Their counselors will review your Medicare statements with you for free, help you understand confusing charges, and walk you through the fraud reporting process. Visit smpresource.org or call 1-877-808-2468 to find your local SMP.

Am I financially responsible for fraudulent charges billed under my Medicare number? No. You are not responsible for paying for services that were fraudulently billed under your Medicare number. Once fraud is confirmed, Medicare will remove the charges and you will not owe any money for those services. However, it is your responsibility to report suspicious charges as soon as you notice them. The longer fraud goes unreported, the more difficult it becomes to resolve and the greater the potential harm to your medical records.

Can someone use my Medicare number to get prescription drugs? Yes. If a scammer has your MBI, they can potentially use it to fill prescriptions in your name. This is a form of Part D fraud. Signs include receiving Explanation of Benefits statements for medications you never ordered, calls from pharmacies about prescriptions you did not request, or changes to your Part D plan that you did not authorize. Report any suspicious prescription activity to your Part D plan and to 1-800-MEDICARE.

The Bottom Line

Medicare fraud is a multibillion-dollar industry, and scammers are constantly refining their tactics. The best defense is knowledge combined with healthy skepticism. Never share your Medicare number with anyone who contacts you unsolicited. Review your Medicare Summary Notices every quarter. If something looks wrong, report it — you are not just protecting yourself, you are protecting the entire Medicare system for every beneficiary.

Remember the core rule: Medicare will never call you to ask for your personal information. If someone calls claiming to be from Medicare and asks for your number, your Social Security number, or your bank details, it is a scam. Hang up, and call 1-800-MEDICARE directly if you have any concerns. Trust your instincts — if something feels wrong, it probably is.

For additional help, your State Health Insurance Assistance Program (SHIP) and Senior Medicare Patrol (SMP) offer free, unbiased counseling. These programs exist specifically to help you navigate Medicare safely and catch fraud before it causes serious harm.