Healthcare & Benefits · Fraud Guide
Medicare / Health Insurance Fraud
Also known as: Medicare Scam, Open Enrollment Scam, Medicare Card Scam
HIGH
Severity
$1,000–$10,000 (plus identity theft risk)
Typical Loss
727
Articles in Archive
Who is targeted: Medicare beneficiaries — virtually all Americans aged 65+. Scammers target people during open enrollment periods.
Individual victims face both financial losses and medical identity theft, which can corrupt health records.
Phase 1 · Awareness
▼
Medicare will never call you to ask for your number over the phone.
Scammers call pretending to be from Medicare or an insurance company. They claim you need a new card, are eligible for a special plan, or qualify for free equipment. Their goal is to steal your Medica...
Key signs:
⚠ Unsolicited call asking for your Medicare number.
⚠ Free equipment or testing offered in exchange for your information.
⚠ Pressure to switch plans immediately.
Scammers call pretending to be from Medicare or an insurance company. They claim you need a new card, are eligible for a special plan, or qualify for free equipment. Their goal is to steal your Medicare number for identity theft and fraudulent billing.
How It Works
1
A call claims you need a new Medicare card or your benefits are changing.
2
They ask to 'verify' your Medicare or Social Security number.
3
During open enrollment, scammers pose as insurance agents.
4
Some offer 'free' testing or equipment in exchange for your Medicare number.
5
Your stolen number is used to bill for services you never received.
All Warning Signs
⚠ Unsolicited call asking for your Medicare number.
⚠ Free equipment or testing offered in exchange for your information.
⚠ Pressure to switch plans immediately.
⚠ Threats of losing benefits.
⚠ Medicare statements for services you never received.
Phase 2 · Prevention
▼
Protecting your Medicare benefits.
Guard your Medicare number like a credit card.
Never give it to someone who calls you.
Medicare will not call you unsolicited.
Contact Medicare yourself at 1-800-MEDICARE.
Review your Medicare Summary Notices.
Check for services or equipment you didn't receive.
Guard your Medicare number like a credit card.
Never give it to someone who calls you.
Medicare will not call you unsolicited.
Contact Medicare yourself at 1-800-MEDICARE.
Review your Medicare Summary Notices.
Check for services or equipment you didn't receive.
Only work with licensed agents during open enrollment.
Verify through your state's department of insurance.
Refuse unsolicited offers of free medical equipment.
If they want your Medicare number, it's a scam.
Phase 3 · Detection
▼
Signs your Medicare identity may be compromised.
Watch for:
🔍 Statements for services you didn't get.
🔍 Records of conditions you don't have.
🔍 Told you've reached benefit limits for services you never used.
Immediate action:
→ Call 1-800-MEDICARE to report.
All Warning Signals
🔍 Statements for services you didn't get.
🔍 Records of conditions you don't have.
🔍 Told you've reached benefit limits for services you never used.
🔍 Bills from providers you've never visited.
What To Do Right Now
→ Call 1-800-MEDICARE to report.
→ Contact the Medicare fraud hotline: 1-800-HHS-TIPS.
→ Request a new Medicare card if your number was stolen.
→ File at ic3.gov.
Phase 4 · Recovery
▼
Recovery after Medicare fraud.
First steps:
→ Report to Medicare at 1-800-MEDICARE.
→ Contact HHS Inspector General at 1-800-HHS-TIPS.
→ Request medical records to check for inaccuracies.
Financial Recovery
→ Report to Medicare at 1-800-MEDICARE.
→ Contact HHS Inspector General at 1-800-HHS-TIPS.
→ Request medical records to check for inaccuracies.
→ Place a fraud alert on credit reports if SSN was compromised.
Emotional Recovery
You were targeted because you have Medicare — not because of anything you did.
Contact the National Elder Fraud Hotline at 833-372-8311.
From the Archive
727 articles about medicare / health insurance fraud
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