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How to Avoid Medicare Scams and Fraud – Share with Clients

Posted by WAP Team on 9/18/17 12:59 PM


An average of around 38 million individuals are enrolled in original Medicare each month according to the CMS Medicare Enrollment Dashboard. Including Medicare Advantage and other health plans, that figure jumps to around 57 million. As such a large program, it’s no wonder Medicare is the target of a variety of scams and fraudulent practices.

Phone Scams

Medicare participants are frequently the victims of phone scams. The scammers call Medicare participants pretending to be employees of CMS, or possibly of the Social Security Administration or another agency.

Their story changes. They may say the participant owes money, for example, and payment must be made right away to avoid dire consequences. They may say they just need to update the participant’s files, possibly so a new card can be issued. Other ploys include saying that the participant will lose coverage unless immediate action is taken.

Whatever they say, their goal is the same. They are trying to trick the participant into revealing personal information, especially the Medicare number and bank account information, which can then be used in an identity theft scheme. Don’t fall for it. Real CMS agents don’t operate this way. Hang up and report the scammer.


Fraud is another major issue to be on the lookout for. To help spot fraud, recommends reviewing your Medicare Summary Notices, the statements listing services and supplies issued every three months.

If the services and supplies listed don’t match your personal records – for example, if there’s a claim for a service you never received – you’ll need to take action. If you know the provider, you can call to see if there was a mistake or misunderstanding. If you don’t know the provider, you should report it as suspected fraud. 

Free Supplies

For a Medicare participant living on a tight budget, the offer of free supplies or exams might sound too good to turn down. Unfortunately, it’s actually too good to be true. The Federal Trade Commission warns that offers of free supplies or exams are one common technique to trick participants out of their personal information.

In general, if a stranger calls you out of the blue with an amazing offer, don’t give out your personal information. The caller is most likely setting you up for identity theft or Medicare fraud.

Scammers have existed for a long time, and they’re not likely to go away. The good news is that you can protect yourself from becoming the next victim.   

  1. Know the risks.
  2. Monitor your Medicare records and financial accounts.
  3. Don’t give out your personal information to strangers.

Topics: Medicare scams

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