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Medicare Beneficiaries Can Help Spot and Stop Medicare Fraud

Medicare and its more than 62 million beneficiaries are under attack from an army of scammers eager to pillage the program. Their primary aim is defrauding Medicare itself, costing the program billions of dollars a year. Their schemes often rely on targeting beneficiaries directly, stealing their identities or enlisting them as unwitting accomplices.

Medicare fraud usually involves rogue health care providers or medical suppliers who bill the program for services, equipment or medication that they don’t actually provide, or else inflate the cost of those items. Some will even falsify patients’ diagnoses to justify unnecessary tests, surgeries and other procedures or write prescriptions for patients they’ve never examined. Others use genuine patient information, sometimes obtained through identity theft, to create fake claims.

Amid the coronavirus pandemic, scammers are targeting beneficiaries with offers of free COVID-19 tests in exchange for their Medicare number or other personal information, according to U.S. Department of Health and Human Services' Office of Inspector General. The data can be used for medical identity theft, and victims could end up bearing the cost of an unapproved test or treatment.

Beneficiaries bear some of the cost of rampant Medicare fraud, as the program’s losses translate into higher deductibles and copayments. These scams can also be harmful to your health. If shady operators obtain your Medicare number and bill the program for phony prescriptions or unnecessary medical equipment, you could be denied coverage later for drugs or devices you genuinely need. There are precautions you can take to avoid getting mixed up in Medicare fraud.

You can help spot and stop Medicare fraud by heeding these warning signs:

  • You receive robocalls, emails or other communications offering medical services or supplies for free if you provide your Medicare number.
  • A clinic or other health care facility advertises free services or consultations specifically for Medicare patients.
  • A doctor or other provider claims to know how to get Medicare to pay for items or services that normally are not covered.
  • Your Medicare Summary Notice (MSN) — the statement you get from Medicare listing recent claims by health care providers — includes services, procedures or devices you did not receive. 

To report suspected Medicare scams:

  • Call Medicare at 800-633-4227 (877-772-3379 if the issue is a suspicious charge on your Medicare Part D prescription drug plan).
  • Contact the Senior Medicare Patrol (SMP) for your area. SMPs are government-funded, volunteer-run organizations that can help you detect and report Medicare scams.
  • Contact the AARP Fraud Watch Network at 877-908-3360 – call our free helpline if you or a loved one suspect a scam.
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