Medicare and Health Insurance Scams: What Seniors Need to Know to Stay Safe

How Medicare and Health Insurance Scams Work

Scammers use a range of tactics to deceive individuals, often through unsolicited contact by phone, email, or even door-to-door visits. Here’s a look at some of the most common approaches:

1. Unsolicited Phone Calls

   • Scammers call, claiming to be from Medicare, and say they need your Medicare ID number or Social Security number to “update your account” or send a “new Medicare card.” Medicare does not make such calls, but scammers count on the familiarity of the Medicare name to build trust.
   • Some fraudsters might even pretend to be from private insurance companies, asking for sensitive information under the guise of verifying or updating health coverage.

2. Phishing Emails and Text Messages

   • These scams come in the form of emails or text messages that look like official Medicare or health insurance communications. They may prompt you to click on links to “verify your account” or “claim your benefits.” Often, these links lead to fake websites designed to steal your information, or they may download malware onto your computer.

3. Door-to-Door Visits

   • In some cases, individuals claiming to be Medicare agents may show up at your home, offering free medical services or equipment in exchange for your Medicare information. This personal approach can make the scam seem more legitimate, but it’s important to remember that Medicare representatives do not conduct door-to-door visits or offer products.

4. Fake Medical Services and Equipment Offers

   • Scammers might reach out with offers for free health screenings, genetic testing, or durable medical equipment, such as braces or wheelchairs. They request your Medicare number to “cover” the service or equipment but instead use it to bill Medicare for unnecessary or nonexistent items.

Real-Life Example of a Medicare Scam

One alarming case involved a company fraudulently billing Medicare over $200 million for unnecessary or fake medical equipment, such as back braces and urinary catheters, that patients never requested or needed. Many victims only found out when they checked their Medicare Summary Notices and noticed unfamiliar charges. Senator Mike Braun commented on the systemic issue, stating, "These scams have gone unchecked for too long, and we need stronger systems to catch them before they harm our seniors." This case led to discussions on using AI technology to help Medicare detect and prevent fraud.

How to Protect Yourself from Medicare and Health Insurance Scams

The good news is there are clear steps you can take to protect yourself from falling victim to these scams:

1. Guard Your Personal Information

   • Never share your Medicare number, Social Security number, or bank information with unsolicited callers, visitors, or emails. Medicare will not call or visit you to sell products or ask for personal information.
   • Keep your Medicare card in a safe place. Treat your Medicare ID number with the same care as your credit card or Social Security number.

2. Verify Contact Sources

   • If you receive a call from someone claiming to be from Medicare or a health insurance provider, hang up and call the official number listed on your Medicare card or other official documents. This simple step can prevent you from giving information to a scammer.
   • Avoid using search engines to look up contact information for Medicare; scammers sometimes create fake websites to trick people searching for help.

3. Be Skeptical of “Free” Offers

   • Be cautious of unsolicited offers for “free” medical services, screenings, or equipment. These offers often come with a hidden agenda to obtain your Medicare information for fraudulent purposes.
   • Legitimate Medicare-covered services don’t require sharing personal information with anyone other than your healthcare provider.

4. Review Your Medicare Statements Regularly

   • Regularly check your Medicare Summary Notices and Explanation of Benefits statements. Look for any unfamiliar charges, especially for services or items you didn’t receive. Reporting these discrepancies can help Medicare detect and prevent fraud.

5. Report Suspicious Activity

   • If you suspect that you’ve been targeted or fallen victim to a Medicare scam, report it. Reporting helps authorities track fraudulent activities and prevent other seniors from being affected.

Where to Report Medicare Scams

1. Medicare

   • Report suspected Medicare fraud directly to Medicare at 1-800-MEDICARE (1-800-633-4227). They can guide you on the next steps to secure your information and prevent further misuse.

2. Senior Medicare Patrol (SMP)

   • Senior Medicare Patrol (SMP) programs offer free education and assistance to seniors. They help identify, prevent, and report Medicare fraud. You can find the SMP in your state using their SMP Locator or call the national number at 1-877-808-2468.

3. Federal Trade Commission (FTC)

   • Report Medicare scams to the FTC at ftc.gov/complaint. The FTC tracks and investigates various scams, and your report can help protect other individuals from similar fraud.

4. Better Business Bureau (BBB)

   • The BBB allows you to report scams and provides additional resources to protect yourself. You can visit their BBB Scam Tracker to see current scams in your area and file a report.

Protect Yourself and Others

Medicare scams can be intimidating, but knowing the warning signs and taking preventative measures can make a huge difference. Remember, Medicare representatives will not call, email, or visit you unannounced to ask for personal information. When in doubt, trust your instincts—pause, verify, and reach out to trusted contacts before providing any information.

By staying informed and vigilant, you can protect yourself and your loved ones from the costly and emotional effects of Medicare scams. Share these tips with friends and family to help keep our community safe.