By The cost of prescription drugs, home care and other medical expenses is one less thing to worry about thanks to Medicare, which assists people aged 65 and older with their medical costs. Unfortunately, with millions of seniors currently enrolled in Medicare plans, it’s common for fraud and abuse of this program to take place. Thankfully, knowing what to watch for can help you stay safe. Keep reading to learn more about Medicare scams that could impact you and how to avoid becoming a victim.
What is considered Medicare abuse?
Medicare abuse is when people fall victim to schemes offering free medical supplies or claims about refunds in exchange for social security numbers, Medicare numbers and credit card information. The FBI estimates that around $3 billion in losses occur annually from Medicare abuse and other kinds of fraud.
“Scammers often prey on the elderly because this demographic has built up savings over years of work experience as well as a credit history, which makes them the ideal target for credit card fraud,” says Ari Parker, the lead licensed Medicare advisor at Chapter.
He adds that Medicare fraud and abuse can be caused by providers, beneficiaries, and scammers—and generally results in higher costs and taxes for everyone.
Parker notes that one of the most common forms of Medicare abuse is scams. This is where scammers act as Medicare professionals to solicit personal or medical information that allows them to steal from older adults.
The most common Medicare scams
Below are prevalent scams used in Medicare abuse:
Cancellation of benefits
This is one of the most common scams that impact older adults. “You may get a call claiming your Medicare benefits are at risk, and they will pressure you with urgency to give them your personal information,” says Dan Hardle, chief executive officer at Medicare Advocates. “This is always a scam.”
He does add that some private insurers may leave a message to let you know that they are leaving the area and that you need to find new coverage, but you are given sufficient notice first. This is most often done via mail or member portal, so these are the best places to check.
Offer for free medical supplies
Scammers sometimes target mature adults by offering them “free” medical supplies. For instance, they may entice people with durable medical equipment or medical checkups at “no cost to you” and say Medicare will cover it. These thieves will then ask for your Social Security number or Medicare number to verify coverage for their shipping costs.
Promise of a refund
In the case of this scam, someone will tell you are owed money back from prescriptions, durable medical equipment (DME) or medical services in the form of a refund or rebate.
“In order to receive this money, they will ask for your Medicare number, personal information, or billing details,” explains Hardle. “If this call does not come directly from your healthcare or insurance provider, it is likely a scam.”
New Medicare card
“This scam is becoming more common over the past few years,” says Hardle. “They may claim that they have a version that is ‘more secure’, or it may just be a newer version.”
Most of the scammers will claim to be from Medicare and ask for personal information. They will then use what they collect to commit identity fraud, access finances, etc.
Fake Medicare websites
Phishing emails are one of the most common ways that cyber criminals target victims—and Medicare-related scams are no exception. Scammers create fake Medicare email addresses that can redirect you to a website that looks identical to the real Medicare.gov page.
Once you are prompted to enter your personal information on the fake website, it’s theirs for the taking.
How is Medicare fraud reported?
If you suspect you or your loved one has been a victim of Medicare fraud, you’ll want to act as quickly as possible. “Immediately contact Social Security and Medicare to report,” says Elissa Ball, Medicare insurance advisor and broker with Advocate Health Advisors.
For particularly serious cases, outside help might be necessary to navigate the situation.
“If you are overwhelmed or the fraud has grown beyond your scope, consult an attorney who specializes in Medicare fraud,” adds Hardle. “They will help you know how to proceed and deal with any or all legal repercussions.”
Even if you’ve just been targeted by a scam but didn’t reveal information, it can be worthwhile to let Medicare representatives know. Experts recommend having your Medicare number handy and all the details about the suspicious activity, like claims, phone numbers, invoices or emails.
Hardle says it’s also a good idea to keep an eye on your Medicare Summary Notices (MSNs) to look for any fraudulent services or providers. Anything that raises a red flag should immediately be reported.
How to protect yourself from Medicare fraud
Though Medicare scams happen frequently, there are steps you can take to stay safe.
- Don’t give out information to untrusted sources. “The only persons you may trust with your identification information are your agent or broker,” says Ball. “Always assume the worst when someone reaches out to you.” Contact your agent or Medicare directly if you have a concern.
- Watch for suspicious emails. Don’t click on any links or share information via message. Instead, log in to your Medicare.gov account directly or your insurance account to update your information and verify your data.
- Ask for a replacement card online. If you lost your card and need a new one, you can go to the Medicare.gov website to request it directly.
Overall, staying vigilant and knowing the signs of fraud can help you avoid becoming a victim.
“Other scams may offer free services, cheaper coverage or send you fraudulent charges,” shares Hardle. “Always pay attention to who you are talking to, what services you are being charged for and how your information is going to be used.”
What Medicare plans have the most secure coverage?
With thousands of Medicare plans available throughout the country, finding the right one for you is key. According to Parker, plans should take into account a person’s doctors, specialists, prescription drugs, and financial situations.
“Many Medicare brokerages may try and steer you into a plan that does not put your best interests first,” Parker notes.
Sadly, there are some unscrupulous agents out there who may try to switch your Medicare insurance coverage for financial gain in the form of commissions, adds Ball. This means you could end up in a plan that was worse than what you already had.
For that reason, Parker recommends working with an independent Medicare broker to ensure that you’ll find the best plan for your needs that offers the most comprehensive coverage at the most affordable cost.
