Medicare and Health Insurance Scams

Medicare and health insurance scams have become more sophisticated, posing significant risks to older and other vulnerable individuals. These scams often seek to exploit personal information and fraudulently obtain financial or medical benefits. Scammers utilize various tactics such as spoofing caller IDs, using urgent or threatening language, and requesting sensitive data under false pretenses.

Scammers posing as Medicare representatives often call to extract personal information or offer unnecessary services, charging Medicare for fake tests or medications. Telemarketing and phone scams are particularly effective, as repeated offenders exploit the vulnerabilities of seniors by sharing their contact information. Understanding how these scams operate and recognizing red flags are crucial steps toward protection.

Common schemes targeting Medicare beneficiaries

Spoofed caller IDs

Scammers often use spoofed caller IDs to make it appear as if they are calling from a legitimate government agency or health provider. This tactic aims to build trust and lower the guard of their targets. A common scam involves convincing beneficiaries that they need to provide personal information to receive a new Medicare card with a chip, even though such cards do not exist. Sometimes, they threaten that the current card will stop working, inducing panic to coerce victims into sharing sensitive data.

Fake plan phishing

Another prevalent tactic is to offer beneficiaries “better” or cheaper supplemental plans not provided by Medicare. These offers can come via phone, email, or postal mail, convincing individuals to divulge personal information to secure these fake plans. The urgent tone of these messages is designed to prevent critical thinking and prompt immediate action from the potential victim.

Impersonating representatives

Scammers may also pose as Medicare representatives offering refunds or rebates. They create a sense of urgency to get victims to confirm their billing details quickly. This technique capitalizes on the promise of monetary gain to exploit their targets.

Threats of cancellation

Threats of Medicare plan cancellation is another effective scam. Perpetrators claim that Medicare benefits will be terminated unless the victim provides personal details immediately. This fear tactic compels quick compliance without time for verification.

Offers of freebies

Finally, offers of free medical supplies or tests lure beneficiaries into giving their Medicare numbers. These scams exploit the desire for free healthcare benefits, subsequently using the victim’s information to submit fraudulent claims.

New Medicare/Social Security card scams

A notable scam type includes fraudsters claiming that Medicare beneficiaries need to obtain new cards. This tactic gained momentum in 2018 and 2019, when legitimate new Medicare cards with randomly generated ID numbers were introduced to reduce identity theft. Though the official change has been implemented, scammers continue to exploit confusion by insisting beneficiaries need new cards or replacements, often suggesting that existing cards are outdated or insecure. False claims about needing a plastic chip card have also been reported. Always be cautious: Medicare doesn’t issue plastic chip cards.

Health insurance scams - common red flags

Unsolicited contact

Unsolicited contact is a major red flag. Genuine marketplaces or insurance companies should never reach out unsolicited to request personal details or payments. Watch out for anyone asking for payment methods such as credit card information, gift cards, or cryptocurrencies—especially if the request is made under the guise of securing your health insurance coverage. Fraudsters often employ these tactics to garner quick, untraceable money.

Urgent requests

Urgent or alarming messages are another warning sign. Scammers often use threatening language to create a false sense of urgency. They might claim that your coverage will be canceled or that you will face legal action if you do not comply immediately. Legitimate institutions will not communicate in this manner and will never threaten you.

Information requests

Requests for personal or financial information should always be treated with suspicion if they come from unverified sources. Always ask for verification, such as the caller’s name, organization, ID number, and contact details. Cross-reference this information with official channels before providing any information. Never share your Social Security number, banking details, or personal health information unless you are absolutely certain of the identity of the requester. When in doubt, it’s always best to hang up and call back at an official number on the organization’s website.

Specialized scams targeting older americans

Medicare call scams

Scammers specifically target older adults with phone calls pretending to be Medicare representatives. These calls often involve robocalls or live agents who claim to be from Medicare. The scammer may use convincing language, like suggesting they need to update Medicare records or offer new benefits, to collect personal information such as Medicare numbers or Social Security numbers.

Older adults are often targeted due to several societal factors. They may have substantial savings, and are more likely to be home to answer the phone. Additionally, a lack of familiarity with technology can make it easier for scammers to manipulate them. According to the FBI Internet Crime Complaint Center (IC3), in 2022, there were 88,262 complaints of fraud from people age 60+, resulting in $3.1 billion in losses, an 82.35% increase from 2021.

To try and protect against these scams, older adults should be educated to never give their Medicare number to unsolicited callers and always verify the authenticity of calls by reaching out directly to Medicare using publicly available phone numbers. Tips from Medicare.gov also suggest never joining a Medicare plan over the phone unless the call was initiated by the individual.

Elder fraud

Elder financial exploitation is defined as the illegal or unauthorized use of an older person’s funds, property, or assets, which can result in a loss of independence for the victim. Perpetrators can be family members, caregivers, or strangers, making it a complex issue to navigate. In 2022, older Americans lost over $724 million due to government impersonation and tech support scams.

Preventive measures include appointing a trusted contact person, planning ahead for diminished capacity and illness, and securely managing sensitive documents like bank statements and unused credit card offers. Working closely with banks or credit unions also provides an added layer of protection.

Notable scam examples in 2024

False billing for diabetes treatment

Scammers have targeted diabetes patients by falsely billing Medicare for Continuous Glucose Monitors (CGMs). Healthcare suppliers often bill Medicare for CGMs that patients never received, exploiting the patient’s Medicare information for unauthorized claims. Additionally, some providers bill for CGMs that are not medically necessary, prescribing them to patients who do not meet Medicare’s criteria for coverage.

Flimsy medical equipment

A new scam in 2024 involves billing for substandard or unnecessary medical equipment. Victims receive unsolicited calls offering “free” diabetic supplies or other medical aids, such as heating pads or orthotics. These items are then billed to Medicare without proper authorization or medical necessity, resulting in fraudulent charges on Medicare summary notices. In one instance, over $231 million worth of medical equipment, including substandard goods, was seized during a national enforcement action targeting healthcare fraud.

Bogus genetic testing

Scams involving unwarranted genetic tests have increased. Fraudsters send genetic testing kits to Medicare beneficiaries without a physician’s order and then bill Medicare for the tests. Unsuspecting victims receive a call instructing them to use the kit, with assurances that Medicare will cover the cost. These scams often culminate in thousands of dollars worth of unauthorized claims. Federal investigators have found labs paying kickbacks to doctors to illegally sign off on these tests.

Hospice fraud

Fraudulent claims related to hospice care services are also on the rise. In 2024, a coordinated enforcement action revealed executives distributing adulterated and misbranded medications while billing Medicare for services that either weren’t provided or were unnecessary. This resulted in over $146 million in fraudulent claims associated with addiction treatment schemes, including hospice care. Such fraud undermines patient care and burdens the tax system, diverting crucial resources from those genuinely in need.

Protecting yourself from fraud

Guard your Medicare number

Treat your Medicare number like a credit card – never share it with anyone who contacts you unsolicited. Check the receipts and statements you get from providers for mistakes, and call your provider’s office if you think a charge is incorrect. Regularly monitor your Medicare statements for unfamiliar charges or discrepancies. Knowing how Medicare uses your personal information can also help you avoid scams.

Be skeptical of any deals or services that seem too good to be true. Offers of money or gifts for free medical care should always be declined, and you should never allow anyone other than your Medicare providers to review your medical records or recommend services.

Review Medicare claims for errors

Compare the dates and services on your calendar with the Medicare statements you receive to ensure that you actually received each service listed and that all details are accurate. This vigilance can help you spot inconsistencies or false charges that might be signs of fraud. In case of discrepancies, contact your healthcare provider for clarification. If you suspect fraud, call 1-800-MEDICARE (1-800-633-4227) or reach out online. For issues related to Medicare Advantage or drug plans, the Investigations Medicare Drug Integrity Contractor (I-MEDIC) can be contacted at 1-877-7SAFERX (1-877-772-3379).

Tips to prevent fraud

Never provide personal information to unsolicited callers. Medicare will never call you on the phone unsolicited. Only accept calls from Medicare if you’ve contacted them or filed a report of suspected fraud, and a representative is expected to follow up. Unsolicited offers for free medical supplies or tests for your Medicare number should be a major red flag.

To try and further protect yourself, keep a close eye on your Medicare account. Safely store and dispose of data that contains your personal information. Use secure passwords and consider identity theft protection services to monitor and alert you of any suspicious activities involving your Medicare number.

Steps to take if you fall victim

Reporting Medicare fraud and abuse

If you suspect fraud, report it immediately by contacting Medicare at 1-800-MEDICARE (800-633-4227). To help them assist you better, have all relevant information ready when you call, such as the date and nature of the fraudulent activity and your Medicare number. This helps streamline the investigation and ensures that all necessary details are documented. For more information, visit..

Federal Trade Commission (FTC)

Filing a complaint with the FTC adds another layer of action against fraudulent activities. If you have experienced Medicare fraud or suspect it, report it to the FTC. The FTC manages records and can provide additional resources to help you understand the steps you need to take to protect yourself further.

Investigations Medicare Drug Integrity Contractor (I-MEDIC)

If the fraud involves Medicare drug plans, you should also report it to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) by calling 1-877-7SAFERX (1-877-772-3379) or visiting I-MEDIC specializes in investigating and addressing fraud specific to Medicare Part D and Medicare Advantage plans.

Immediate reporting helps trigger an investigation and potentially stops scammers from continuing their fraudulent activities. Consistent follow-up is essential, as in some reports from individuals, reaching back multiple times might be necessary due to system errors or follow-up processes. By taking these steps, you reinforce efforts to protect not only yourself but also the broader community from ongoing Medicare fraud.

Resources and support systems

SMP (Senior Medicare Patrol)

SMP (Senior Medicare Patrol) plays a critical role in helping beneficiaries to detect and report healthcare fraud, errors, and abuse. These patrols, funded by the U.S. Administration for Community Living, provide extensive outreach, counseling, and education to Medicare beneficiaries. Beneficiaries can utilize SMP resources to understand the red flags of fraudulent activities and learn effective ways to protect their personal information.

SMPs empower beneficiaries through tools and resources designed to prevent scams. This includes periodic educational materials, fact sheets, and public service announcements that increase awareness about the modus operandi of scammers.

The SMP website offers easy access to these educational resources, including step-by-step guides on how to report potential fraud. They support beneficiaries in understanding and verifying their Medicare statements, which can help in identifying unauthorized or suspicious charges. Referrals to Medicare contractors for follow-up on questionable claims are also a part of SMP’s assistance, with 1,700 cases referred annually.

The increasing sophistication of Medicare and health insurance scams, especially those targeting seniors, underscores the necessity for widespread education, robust reporting systems, and rigorous enforcement actions. Staying informed about common tactics is essential for safeguarding personal information.

Utilizing available resources like the Senior Medicare Patrol (SMP) and regularly reviewing Medicare statements can help beneficiaries detect and report fraud more effectively. By leveraging these services and maintaining constant vigilance, we can collectively try to diminish the impact of these fraudulent activities, ensuring the integrity and sustainability of Medicare services for all.