With Medicare open enrollment season about to begin, it’s a good idea for enrollees to recognize and take action to stop Medicare fraud against them in its tracks.

Just how bad is the Medicare consumer fraud problem? According to the Coalition Against Insurance Fraud, Medicare fraud — against consumers, government, and private health insurers — is the “largest type of insurance fraud by far,” with tens of billions of dollars lost each year by consumers.


Forms of Medicare Fraud

There are several ways that Medicare enrollees can be victimized by fraud. These scams are at the top of that list:


Via phone — Identity fraudsters often target older Medicare enrollees via a phone call, telling seniors they’re with the government or a doctor’s office, and try to steal Medicare account data that they later use to commit fraud.


Via email — Medicare fraud artists also frequently use email “phishing” techniques to reach out to Medicare enrollees, again claiming to be from the government or from a local hospital or doctor’s office.

The scammers often try to elicit a Medicare enrollee’s personal data through email directly, claiming they need the user’s personal data to complete some important paperwork, and ask the Medicare beneficiary’s Social Security number and/or bank account and credit card account information.

Or, they’ll attempt to get a senior to click on a malware-loaded email link, which then steals the consumer’s data.


Actions to Protect against Medicare Fraud

The good news? Medicare enrollees can take direct action to mitigate or even eliminate Medicare fraud, experts say.

Get started with these tips:


Lock down your medical information. “Be suspicious if anyone other than your doctor or medical provider asks for your information, especially because this includes your Social Security number,” says Diana Golub, a licensed medical professional and director of options at AIA Direct in Bradenton, Florida.

“Make sure you protect your Medicare card, and don’t share your Medicare number. Think of it like a credit or debit card number. Be aware of online or phone scammers. You don’t have to pay a processing fee or purchase a temporary card should you misplace your Medicare card.”


Review your Medicare claims. Review your Medicare claims to make sure there aren’t any errors or suspicious activity, advises Justin Lavelle, chief communications officer at BeenVerified, an online background-check platform.

“Each time you receive healthcare services, write the service date on your calendar and save all the statements or receipts you may get back from your providers,” Lavelle says.

“Check them for errors by comparing your healthcare service dates — as listed on your calendar — with what is listed on your statements.”

In addition, check to ensure the prescriptions you’ve filled match the ones listed on your statements. If you find any errors, call (800) MEDICARE, Lavelle says.


Don’t accept any services you don’t need. If your provider is putting pressure on you to get healthcare services you feel you don’t need, you can refuse the care and request another physician give you a second opinion.

“Don’t feel that because it is your physician, someone you’ve trusted in the past, that you must move forward with all of their healthcare recommendations,” says Lavelle.

“Medical professionals falsely billing Medicare, advising procedures with higher rates of payment, and filing false claims have been on the rise in the last decade.”


Be careful with all physician interactions. On its fraud-prevention webpage, Medicare.gov advises Medicare enrollees to not allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.

“Also, don’t contact your doctor to request a service that you don’t need, and don’t let anyone persuade you to see a doctor for care or services you don’t need,” the agency states.

If you believe that you’ve been victimized by Medicare fraud, take these action steps:


• Call CMS at (800) MEDICARE or (800) 633-4227.

• Report it online to the Department of Health and Human Services Office of the Inspector General.

• Call the Office of the Inspector General at (800) HHS TIPS or TTY: (800) 377 4950.

• Call your state insurance department or local law enforcement.


Brian O’Connell is an analyst at InsuranceQuotes (www.insurancequotes.com).

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