Fraudsters targeting Medicare beneficiaries in the United States try to obtain their Medicare number and other personal data in order to submit bogus medical claims and pocket the money. They may call, send emails or text messages, or even turn up at your home, posing as employees of Medicare, an insurance company or a medical facility.
According to the Senior Medicare Patrol programme, Medicare loses around 60 billion dollars a year to fraud, errors and abuse, although the real losses may be much higher. One example is the case of a former teacher from California who pleaded guilty to taking part in a 51 million dollar Medicare fraud scheme involving orthopaedic braces that patients had neither ordered nor used.
Experts from the National Council on Aging (NCOA) stress that fraudulent claims can end up in a person's medical record, distorting information about their health and making it harder to prescribe appropriate treatment.
Fraudsters most often use the telephone, but they are also very active via email, SMS, social media and regular post. They may pretend to be representatives of Medicare, doctors, suppliers of medical equipment or insurance agents and can sound very convincing, using modern technology to create fake websites, letters and marketing materials.
Five key signs of Medicare fraud
1. Promises of free goods or services. Any offers of “free” medical equipment, medicines, genetic tests or examinations in exchange for your Medicare number should be treated with suspicion. Often, once they have your number, fraudsters submit expensive claims to Medicare for services you never received.
2. Pressure to switch to a different plan. Fraudsters may claim that you are “pre-approved” for a better plan with lower premiums or better coverage and that you must pay a fee to enrol. Such calls are often disguised as official communications from Medicare.
3. Demands to “update” or “reissue” your Medicare card. They may call and say that you need to activate, renew or upgrade your card, and then ask you to provide your Medicare number or pay a “registration” or “processing” fee.
4. Threats to cancel your coverage. Another common ploy is a message about an alleged problem with your Medicare account, warning that your benefits will be stopped unless you immediately confirm your personal details or switch to a different plan.
5. Claims that you are owed a “refund”. Fraudsters may promise a refund due to changes in your plan and demand your Medicare number or even your bank details, supposedly to transfer the money.
How to protect yourself from Medicare fraud
Specialists advise that you should not share your Medicare or Social Security number with anyone except your doctor, pharmacy or official counsellors who work with Medicare. These details should be protected just as carefully as your bank card information. Medicare does not call you out of the blue and will not ask for your number over the phone, as it already has it on file.
Do not rely on the number shown on your screen alone — it can easily be faked (spoofing). If a stranger asks for your personal data over the phone, it is better simply to hang up.
Experts also recommend paying particular attention to Medicare advertising on Facebook. According to the Center for Countering Digital Hate, fraudulent Medicare adverts on this platform have received more than 215 million views over the past year. Some are disguised as political advertising with fake “endorsements” of plans from well-known politicians, or promise thousands of dollars in “free” benefits under Medicare Advantage.
You should not open suspicious emails or SMS messages or click on links, even if the message looks official. To update your information, you should go directly to the official Medicare.gov website, call 1-800-MEDICARE or contact a trusted adviser.
If you are entitled to Medicare, your benefits cannot be cancelled for the reasons typically cited by fraudsters (for example, because you declined a particular plan). You should also not believe claims that a particular insurance policy is “recommended” or “approved” by Medicare — the programme does not favour specific plans.
If you receive a new Medicare card, you should destroy the old one yourself (cut it up with scissors or shred it). You do not need to send it anywhere, despite what fraudsters may claim. Only doctors and other authorised medical professionals should have access to your medical records.
Experts also warn against unauthorised genetic tests. If you receive a test kit in the post that your doctor has not ordered, you should refuse delivery or return it to the sender.
Where to report suspected fraud
If you or someone you know has fallen victim to Medicare-related fraud, it is recommended that you report it directly to Medicare on 1-800-MEDICARE, contact the Senior Medicare Patrol Resource Center, or file a complaint with the US Federal Trade Commission (FTC) via its online form.
Specialists remind people that fraudsters become particularly active during Medicare's annual open enrolment period (from 15 October to 7 December), when people review their plans and change their coverage.
For impartial advice on choosing a Medicare plan, you can contact the State Health Insurance Assistance Program (SHIP). These organisations provide free guidance to people who are eligible for Medicare, as well as to their families and carers.