[Last updated October 6, 2025]
Medicare provides essential health coverage to millions of older adults, and scammers use its complexity to defraud people of their personal information and money. It can lead to denied claims, bills for services you never received, and the theft of your identity. Being aware of red flags will help you identify Medicare fraud, and adopting a few smart habits will help you protect yourself. Here are our top tips for identifying and protecting yourself from Medicare fraud.
What is Medicare fraud?
Medicare fraud happens when someone (a scammer, a dishonest provider, or even an organized crime ring) illegally uses Medicare to obtain money or personal information. Medicare fraud takes many forms, from stealing personal information to filing false claims and from billing for more costly services to billing for services and supplies that were never provided.
So, what could Medicare fraud look like?
Recognize these Medicare fraud red flags
Here are the most common and current red flags that seniors should look out for in their everyday online, phone, and mail transactions.
Red flag #1: Unsolicited contact from “Medicare”
Scammers often impersonate official agencies to steal information. They rely on the power of the Medicare name to make you drop your guard. Medicare will rarely contact you unless you have initiated the call. They never initiate contact by phone, text, or email to sell you a plan or equipment.
Watch out for:
- A phone call claiming your Medicare card or benefits are about to be canceled unless you immediately verify your number.
- A text message or email asking you to click a link to claim a newly issued Medicare card or verify personal details.
- Door-to-door or in-person solicitors asking for your Medicare number or Social Security number.
Red flag #2: Offers of “free” medical equipment or tests
One of the fastest-growing areas of fraud involves scammers using the promise of something free to steal your Medicare number. They then use that number to bill Medicare for thousands of dollars for nonexistent products or services.
Watch out for:
- Unsolicited packages or calls offering free back braces, knee braces, orthopedic devices, or other medical equipment that your personal doctor did not order.
- Offers for free genetic testing kits or cheek swabs that can detect future diseases.
- Any online, TV, or social media ad offering a Medicare Flex Card preloaded with cash for groceries or gas, especially if it requires you to call a number and provide sensitive information to qualify. (Note: Legitimate flex cards are usually tied to specific Medicare Advantage plans and are not handed out for free via cold calls.)
Red flag #3: High-pressure sales or immediate payment demands
Scammers often create a sense of urgency to bypass your rational judgment. Legitimate Medicare representatives or plans will never pressure you into an immediate decision.
Watch out for:
- A caller or agent demanding that you sign up for a plan right now because the offer is only good for the next 15 minutes.
- Anyone threatening to suspend your coverage, fine you, or send you to jail if you don’t immediately pay a fee or back payment with gift cards, money transfers, or cryptocurrencies.
- An agent or representative promising a plan that sounds too good to be true. The promised plan might include coverage for services you know Medicare typically excludes or offer full coverage with zero premiums, zero copays, and thousands in cash rewards.
Red flag #4: Suspicious charges on your Medicare statement
When suspicious charges appear on your Medicare summary notice (MSN) or explanation of benefits (EOB), it represents the ultimate red flag, indicating that a scammer has successfully used your information.
Watch out for:
- Phantom billing: Charges for services, supplies, or prescriptions you never received.
- Double billing: Being charged twice for the same medical treatment or doctor’s visit.
- Unfamiliar provider: Claims submitted by a doctor or clinic you have never visited.
- Invoices from unknown parties: Receiving a medical bill (regardless of how official and legitimate it looks) from a company or lab you cannot verify.
- Upcoding: Charges for more expensive procedures or items than what you received.
What to do if you suspect Medicare fraud
If you spot a red flag or believe you have been targeted, take action immediately.
- Stop all communication:
- Hang up the phone immediately. If you’re unsure if a caller is legitimate, call Medicare directly at 1-800-MEDICARE.
- Do not click on any links or open attachments in suspicious emails or text messages.
- Do not follow directions to call a different phone number left in a suspicious voicemail or letter.
- Do not provide or confirm information:
- Never give your Medicare number, Social Security number, or financial information to anyone who calls, emails, or visits you uninvited.
- If a person appears to know some of your information, that does not necessarily prove they are legitimate. Scammers often purchase this data. Simply end the conversation.
- Report the fraud:
- Reporting suspected fraud protects you and helps stop criminals from targeting others. Here’s who to contact:
| If the fraud is related to: | Who to call (official U.S. government contacts): |
|---|---|
| Original Medicare (Parts A and B) | 1-800-MEDICARE (1-800-633-4227) |
| Medicare Advantage (Part C) or Medicare drug (Part D) plans | 1-877-7SAFERX (1-877-772-3379) |
When reporting, have your Medicare number, the provider’s name (if known), the service date(s), and the payment amount ready.
Everyday ways to keep your information safe
Protecting your Medicare benefits requires adopting a few simple security habits.
- Guard your numbers: Treat your Medicare ID and Social Security numbers with the same care as you would your credit card numbers. Only share them with trusted, verified doctors, pharmacists, hospitals, or your authorized health insurance plan.
- Review your statements: Scrutinize your Medicare summary notice (MSN) or explanation of benefits (EOB) reports every month. Look for:
- Services you didn’t receive.
- Items you didn’t order.
- Duplicate charges or unfamiliar names.
- Keep a medical log: Use a simple calendar or notebook to record all your doctor appointments, tests, and procedures. If a charge appears on your MSN that doesn’t match your log, investigate it immediately.
- Never accept free gifts or cash: Be highly suspicious of any provider or agent offering money, gift cards, or free services in exchange for your Medicare information. Not only is that illegal, but it’s also a classic tactic to get your number.
- Use the Senior Medicare Patrol (SMP): SMPs are state-level resources funded by the federal government that can help you understand your Medicare rights, detect fraud, and report it. You can call 1-877-808-2468 to find your local SMP.
Medicare fraud thrives on secrecy and fear. By staying alert to the latest red flags, you empower yourself to protect your identity and your Medicare benefits. Remember that with every scam you stop, you protect not only yourself but the integrity of the entire Medicare program.
