How to Prevent Medicare Fraud and Report it to the FBI

Author

Seth Combs
June 06, 2024

If you’ve been a victim or know a victim, please contact us and we will try to assist

Table of Contents

Warning Signs of a Medicare Scam

As part of Medicare Fraud Prevention Week, I want to share important tips for keeping you and your loved ones safe.

The biggest tip you should know and share:

Medicare will not call you uninvited, ask for your Medicare number, or ask for personal information.

Watch for the following warning signs of a scam:

  • Unsolicited calls, emails, or visits: someone contacting you out of the blue, claiming to be from Medicare and offering free services.

  • Requests for personal information: a demand for your Medicare number, Social Security number, or other personal information.

  • Pressure to act quickly: any threat that you'll lose benefits or face other consequences if you don't comply with a deadline, often by paying or providing personal information.

  • Billings with errors: charges for services or supplies that weren’t ordered, were never received, or that Medicare already covered.

  • Suspicious websites or mailings: fake websites created to look like official ones but that have inconsistencies, errors, or other odd elements.

How to Reduce Your Risk of a Medicare Scam

With the rapid rise of Medicare scams taking place, it’s important to protect yourself. Here are some tips for reducing your risk:

  • Only share your Medicare and Social Security numbers with your doctor or people you know should have this info (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP). Get the contact information for your local SHIP.

  • Carry your Medicare card only when you need it.

  • Keep a record of all your medical visits and procedures.

  • Carefully review Medicare statements for mistakes and charges you don’t recognize.

  • Beware of “free” services. If you're asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged to your insurance company.

  • If your Medicare card is lost or stolen, log into (or create) your secure Medicare account to print or order an official copy of your Medicare card. You can also call 1-800-MEDICARE (1-800-633-4227) to order a replacement card to be sent in the mail. TTY users can call 1-877-486-2048.

The Senior Medicare Patrol offers complimentary access to their Medicare Health Care Tracker, which can help with keeping records and reviewing statements.

Common Types of Healthcare Fraud and Scams

Every week, there seems to be another Medicare scam taking place. By staying educated and diligent about your information, you can stay safe. Here are some common types of fraud and scams.

Fraud Committed by Medical Providers

  • Double billing: Submitting multiple claims for the same service

  • Phantom billing: Billing for a service visit or supplies the patient never received

  • Unbundling: Submitting multiple bills for the same service

  • Upcoding: Billing for a more expensive service than the patient received

Fraud and Scams Committed by Patients and Other Individuals

  • Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan

  • Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance

  • Impersonating a health care professional: Providing or billing for health services or equipment without a license

Fraud Involving Prescriptions

  • Forgery: Creating or using forged prescriptions

  • Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication

  • Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices

How to Report Medicare Fraud to the FBI and Other Services

If you or someone you know has been a victim of Medicare Fraud or Scams, it’s important to report it. The FBI is the primary agency for investigating healthcare fraud, for both federal and private insurance programs in partnership with:

  • Federal, state, and local agencies

  • Healthcare Fraud Prevention Partnership

  • Insurance groups such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units

You can report suspected healthcare fraud to the FBI by visiting: https://tips.fbi.gov

You can also report Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227) or online by visiting the US Dept of Health and Human Services.