The biggest Medicare fraud warning signs on your statements are charges for services, tests, or equipment you never got, visits on days you weren't seen, and providers you don't recognize. If something looks wrong, call the provider first to rule out a simple error. If it still looks like fraud, report it to 1-800-MEDICARE (1-800-633-4227), the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) at 1-800-HHS-TIPS (1-800-447-8477), or your local Senior Medicare Patrol (SMP) at 1-877-808-2468.
Where do I look for signs of Medicare fraud?
Check every statement that lists your care:
- Medicare Summary Notice (MSN) if you have Original Medicare.
- Explanation of Benefits (EOB) from a Medicare Advantage plan or drug plan.
- Your secure Medicare.gov account, where Medicare says you can view Original Medicare claims as soon as they're processed.
Medicare's "Protecting Yourself From Fraud" booklet suggests recording the dates of your care on a calendar, saving receipts, and comparing them with the claims Medicare processed.
What warning signs should I look for on my statement?
Look for:
- Services you didn't get. A test, visit, or therapy session you don't remember.
- Equipment you didn't get. Medicare's booklet calls out billing for back braces or other orthotics, power wheelchairs or scooters, or genetic tests you don't need.
- Dates that don't match. A visit on a day you were home, out of town, or in the hospital.
- Providers you don't recognize. Check first whether it's a lab, radiologist, or hospital doctor connected to real care.
- The wrong diagnosis. Medicare's booklet lists putting the wrong diagnosis on a claim as a sign of fraud.
- Tests billed while you were an inpatient. The booklet flags billing Medicare for tests you got as a hospital inpatient or within 72 hours of admission or discharge.
- Home health services you didn't need. The booklet mentions billing home health services for patients who aren't confined to their home.
- Claims after you lost your card. That can point to medical identity theft.
What other red flags should I watch for?
Medicare's booklet says to be suspicious of anyone who tells you:
- The equipment or service is free and they only need your Medicare Number "for their records."
- Medicare wants you to have the item or service.
- They know how to get Medicare to pay for it.
- The more tests they provide, the cheaper the tests become.
And be suspicious of providers or companies that:
- Advertise "free" consultations to people with Medicare.
- Claim to represent Medicare or the federal government.
- Use pressure or scare tactics to sell high-priced services or tests.
- Offer money or gifts to use their services or let them use your Medicare Number.
- Use phone calls and door-to-door selling.
- Ask you to call your doctor and request something you don't need.
Medicare.gov also says Medicare will never call you to sell you anything or visit you at home.
What should I do first if something looks wrong?
Call the provider. Medicare's booklet says that if you know the provider, their office may explain the charge or find an error that needs correcting. Some questionable lines turn out to be billing mistakes, like a wrong date or code.
You might say: "My Medicare statement shows a charge from your office for [service] on [date]. I don't remember getting that. Can you tell me what it was for?"
If the answer doesn't make sense, or you've never heard of the provider, report it.