5 Ways to Protect Against Medicare Fraud

man in white medical scrub suit standing beside girl in blue denim jacket

Medicare, a vital resource for healthcare coverage, is unfortunately susceptible to fraud and abuse. As individuals navigate the complexities of healthcare in their senior years, protecting against Medicare fraud and mistakes becomes paramount. It’s essential to learn about fraud and Medicare mistakes to ensure you are prepared for all scenarios. You can learn more about the biggest retirement mistake by visiting https://boomerbenefits.com/the-biggest-retirement-mistake/. In addition to learning how to avoid retirement mistakes, this blog will explore five proactive ways to safeguard your Medicare coverage and financial well-being.

1. Understand Common Types of Medicare Fraud

Knowledge is a powerful defense against fraud. Familiarizing yourself with common types of Medicare fraud empowers you to recognize potential scams and schemes. Typical forms of Medicare fraud include:

  • Billing for Services Not Provided: Providers may submit claims for services or treatments never rendered to the patient.
  • Upcoding: Inflating the cost of services using billing codes that indicate a more complex or costly procedure than what was actually performed.
  • Identity Theft: Fraudsters may use stolen Medicare numbers to bill for fictitious services or equipment.
  • Kickbacks: Accepting or providing kickbacks for referrals or services can lead to fraudulent claims.
  • Durable Medical Equipment (DME) Fraud: Unscrupulous providers may bill Medicare for unnecessary or non-existent medical equipment.

Understanding these tactics enhances your ability to stay vigilant and recognize red flags.

2. Protect Your Medicare Number

Your Medicare number is valuable personal information, and protecting it is crucial. Here are steps to safeguard your Medicare number:

  • Never Share Unsolicited Requests: Be cautious about sharing your Medicare number, especially in response to unsolicited calls, emails, or messages. Legitimate entities will not contact you for this information without prior communication.
  • Use a Secure Patient Portal: When interacting with healthcare providers online, ensure the patient portal is secure and reputable. Avoid sharing sensitive information through unsecured platforms.
  • Regularly Review Statements: Review your Medicare Summary Notices and Explanation of Benefits statements. Report any discrepancies or suspicious charges immediately.
  • Report Lost or Stolen Cards: If your Medicare card is lost or stolen, immediately report it to Medicare. You can request a replacement card if needed.

3. Be Skeptical of Unsolicited Offers

Medicare fraud often involves scammers reaching out with unsolicited offers or requests. Stay vigilant and skeptical of:

  • Unexpected Calls: Be cautious about answering calls from unknown numbers. Legitimate entities will not pressure you into providing personal information over the phone.
  • Door-to-Door Sales: Avoid engaging with individuals who show up unannounced, offering healthcare services or products. Legitimate healthcare providers do not typically conduct business this way.
  • Free Services or Equipment: Be wary of offers for free medical services or equipment in exchange for your Medicare information. Verify the legitimacy of such offers with your healthcare provider.
  • Email and Online Scams: Exercise caution when receiving emails or encountering online advertisements promising free healthcare services or equipment. These may be phishing attempts to collect personal information.

4. Review Medicare Statements Regularly

Regularly reviewing your Medicare statements is a proactive measure to detect discrepancies or unauthorized charges. Here’s how to effectively review your statements:

  • Check for Accuracy: Ensure that the services listed on your statements align with the care you received. Report any services that you did not receive.
  • Verify Providers: Confirm that healthcare providers’ names and information match your healthcare team. If you notice unfamiliar names or entities, investigate further.
  • Monitor Frequency: Be aware of the frequency of services listed on your statements. Unexplained or excessive services could indicate fraudulent billing.
  • Report Suspicious Activity: If you identify any irregularities, promptly report them to Medicare by calling the Medicare Fraud Hotline at 1-800-MEDICARE (1-800-633-4227).

5. Stay Informed and Educated

An informed individual is less likely to fall victim to fraud. Stay educated on Medicare policies, your rights, and the latest fraud prevention measures:

  • Attend Medicare Seminars: Participate in Medicare seminars or workshops to enhance your understanding of Medicare, its coverage, and fraud prevention.
  • Stay Informed About Scams: Keep abreast of the latest scams targeting Medicare beneficiaries. Medicare regularly updates its resources to educate and protect beneficiaries.
  • Verify Providers: Before receiving medical services, verify that your healthcare providers are legitimate and participate in the Medicare program.
  • Utilize Official Medicare Resources: Rely on official Medicare resources and communications for information. Avoid sharing personal information based on unsolicited requests.


Protecting against Medicare fraud is a shared responsibility between beneficiaries and the healthcare system. By understanding common fraud tactics, safeguarding your Medicare number, being skeptical of unsolicited offers, reviewing statements regularly, and staying informed, you play a crucial role in maintaining the integrity of the Medicare program. Your vigilance protects your personal information and financial well-being and contributes to the overall security of the Medicare system for generations to come.