3 Signs Of A Medicare Fraud Or Scam Every Senior And Caregiver Needs To Know

Be wary of offers for free medical supplies.
Here's how to spot and avoid getting entangled in common Medicare scams.
Dobrila Vignjevic via Getty Images
Here's how to spot and avoid getting entangled in common Medicare scams.

“This is Shelly in the Medicare enrollment center, on a recorded line, and I see here in the past you inquired about your Medicare supplement coverage ... ”

This introduction may sound legitimate, but it’s actually an example audio script of a Medicare scam provided by the Federal Communications Commission.

Medicare is the federal health insurance covering Americans 65 years and older along with certain younger people with disabilities and those in the final stages of kidney disease. It provides critical health care services that are top of seniors’ minds — and scammers take advantage of this vulnerability.

Ari Parker, an attorney and lead Medicare adviser for Chapter, a resource for people seeking information about Medicare coverage, said scammers target seniors because they are less familiar with technology and because they have a lifetime of savings built up, along with credit history. “It’s a more lucrative population to target,” he said.

In 2020, Americans over 65 lost an average of $9,175 to scams, the FBI reported. A critical thing for Medicare recipients and caregivers to remember is that just because someone says they are working with Medicare does not mean they are.

Scammers “use the strong branding of Medicare to their advantage. Anyone who is on Medicare respects it,” said Amy Nofziger, director of fraud victim support with AARP, an advocacy group for people over 50. “So when you hear Medicare, ‘problem with your account,’ ‘need a new card,’ you listen and you pay attention a little bit more.”

Nofziger estimated that the AARP fraud help hotline gets about 500 phone calls a day from people experiencing or reporting fraud, including for Medicare.

“Being a victim of a scam has nothing to do your intelligence level, it has to do with ... really, your emotional triggers,” Nofziger said. “A very important thing for so many people is their Medicare, because that’s how they stay healthy and that’s how they have access to doctors and medicine in this country. When someone is threatening them with their ability to stay healthy, they are not thinking cognitively, they are thinking emotionally, they are thinking with fear.”

To get through the cloud of anxiety that a scammer can stir up, it’s important to remember the facts of how Medicare contacts members and beneficiaries. Here are important warning signs that the Medicare offer you are hearing about from a so-called “Medicare representative” is actually a scam.

1. If Medicare is making unsolicited contact with you, keep your guard up. Real Medicare does not need to call you to verify your information.

If you are getting a call, email or door knock out of the blue from someone saying they work with Medicare, be suspicious.

Medicare is not going to contact you to verify your information. As the FCC website states, “Medicare will never call you uninvited and ask you to give us personal or private information.”

“Being a victim of a scam has nothing to do your intelligence level, it has to do with ... really your emotional triggers.”

- Amy Nofziger, director of fraud victim support with AARP

The only two reasons someone from Medicare would call you are if you called the official 1-800-MEDICARE line first and asked for someone to call you back or if you are already a member of a health or drug plan with Medicare. In that case, “the agent who helped you join a Medicare plan can call you,” says the Medicare.gov website.

Be wary of emails claiming to be from Medicare. Parker noted that it is not typical for Medicare to email beneficiaries because it usually communicates information through a person’s Medicare.gov account, where claims and coverage can be viewed.

2. Be wary of offers for free medical supplies and other freebies trying to lure you in in exchange for your Medicare number. This is a number you should be treating like it’s your Social Security number.

If you are being offered free tests or medical supplies but the contact “just needs to get your Medicare card number first,” that’s another red flag. You should be wary of anyone you don’t know who is asking you to share your unique 11-digit Medicare number, which is how Medicare claims are submitted.

“Medicare is not going to be asking for your Medicare number, trust me. Medicare has your number,” Nofziger said.

Nofziger said a typical scenario would include a Medicare scammer telling a senior, “Your doctor let us know that you had knee pain” and offering free medical supplies, which people often fall for because “Tell me someone even over the age of 45 who doesn’t have knee pain,” she said.

In this popular fraudulent scheme, the scammer prescribes equipment like a knee brace and bills Medicare for it once they have your unique Medicare number. But getting unnecessary medical supplies can use up your Medicare benefits and leave you unable to get future supplies and services you actually need covered later on. And getting medical supplies that are not properly fitted to you can also cause you physical damage over time, Nofziger said.

“If someone is using your Medicare number for medical identity theft, perhaps to get treatment or surgery, that’s going on your Medicare number,” Nofziger added. “Let’s say you have an emergency and they pull up your number, and then they are like ‘You already got this care. You were charged for this.’”

Parker said the offer of free medical supplies or “a medical checkup at no cost” is the most common kind of Medicare scam he sees.

Another common scammer tactic, he said, is for a caller to tell someone that they are “eligible for a refund due to a change in coverage.” Then, the caller asks for the person’s Medicare number and bank information.

3. Be wary of people who are not your doctor making health recommendations in exchange for your personal information.

Medicare’s website warns people not to allow “anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.”

That’s because a common Medicare fraud is when a caller may claim that they are a genetic testing company who is working with your doctor and your doctor is worried that you have a common medical history, like cancer in your family, Nofziger said.

Then, the caller typically says, they will send out a genetic test to help you and your doctor figure out a treatment plan –– they just need to verify your Medicare number or your Social Security number first. “They won’t say ‘Can I have it?’ They will say, ‘Can I confirm it?’ You already think they have it because the doctor gave it to them,” Nofziger said.

The scam preys upon people’s health fears to get them to listen. ”It’s almost a bit of reciprocity in there: ‘You give me your Medicare number, I’m going to save your life,’” Nofziger added.

Nofziger noted that the majority of Medicare frauds her team sees originate from phone calls. To avoid getting scammed, she recommends sending any phone call from an unknown number to voicemail. On Apple and Android smartphones, there are features that will filter calls for you, such as a setting that will silence calls from numbers that aren’t in your contacts.

“When you are listening to a voicemail, you are not in that moment with that person. You can then decide are you going to call them back or are you going to listen to the red flags and then delete it,” she said.

If someone calls and asks for your personal information, or threatens your Medicare coverage, you can also hang up and call the official Medicare number 1-800-MEDICARE (1-800-633-4227) to report it.

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