By Brennan Decima. December 2025
Simple steps every Medicare beneficiary should take to prevent identity theft, stop fraudulent billing, and safeguard their benefits.
Medicare fraud and medical identity theft impact millions of Americans every year — costing taxpayers billions and putting your personal health information at risk. It is estimated that senior fraud as a whole cost Americans 60 billion dollars. In 2025, Medicare fraud claims to the BBB increased by 40%. Fraud can happen when someone steals your Medicare Number or uses your identity to submit false claims.
The good news? With a few simple habits, you can dramatically reduce your risk.
This guide breaks fraud prevention down into clear steps so you can stay informed, protected, and confident about your Medicare coverage.
Why Medicare Fraud Matters
Fraud doesn’t just siphon money out of the Medicare system — it can affect your medical records, delay your legitimate care, and expose your personal information. Medicare works with doctors and insurance providers to catch fraud, but the strongest protection is you knowing what to look for.
How to Spot Medicare Fraud
1. Review Your Claims Regularly
Keep track of your appointments and services. Use a notebook or the calendar on your phone to record:
- Dates of doctor visits
- Tests or scans you received
- Any medical equipment provided
Then compare your notes with your Medicare statements.
If you have Original Medicare
You can use:
- Your Medicare Summary Notice (MSN): Shows what was billed, what Medicare paid, and what you may owe.
- Your online Medicare account at Medicare.gov: Lets you view claims in real time and sign up for electronic MSNs.
- 1-800-MEDICARE: You can speak to a real person 24/7 (except some holidays).
If you have a Medicare Advantage or Drug Plan
Review the statements your plan sends you and compare them with your records.
💡 Tip: If something looks incorrect, call your doctor’s office first. Many billing errors are honest mistakes and easily fixed.
Common Signs of Medicare Fraud
Be cautious if someone tells you any of the following:
- “This service is free — I just need your Medicare Number.”
- “Medicare wants you to have this test.”
- “The more tests we run, the cheaper it gets.”
- “We know how to bill Medicare so it won’t cost you anything.”
Also be wary of providers or companies who:
- Bill Medicare for services you didn’t receive
- Advertise “free consultations” for Medicare beneficiaries
- Add diagnoses that you don’t have
- Pressure you into expensive services or genetic tests
- Offer cash, gifts, or gift cards for your Medicare Number
- Show up at your home uninvited
- Offer non-medical perks (groceries, transportation, housekeeping) as “Medicare benefits”
If it sounds too good to be true — it almost always is.
How to Report Medicare Fraud
If something feels off, don’t ignore it. Medicare wants reports from beneficiaries. Reporting is the most effective way the fraud gets caught.
You can report fraud by contacting:
- 1-800-MEDICARE (1-800-633-4227)
- HHS Office of Inspector General Fraud Hotline: 1-800-HHS-TIPS
- Online: tips.oig.hhs.gov
- For Medicare Advantage and Part D plans: I-MEDIC at 1-877-7SAFERX
Before calling, gather:
- Your name and Medicare Number
- The provider’s name
- The date and type of service
- Why you believe the claim is wrong
The more detail you provide, the faster investigators can act.
Protecting Yourself From Medical Identity Theft
Your Medicare Number is valuable. You should treat it like a credit card.
Do:
- Share your Medicare Number only with trusted medical professionals.
- Hang up on any unsolicited call asking for personal information.
- Call Medicare if your card is lost or you suspect unauthorized use.
- Use SSA.gov if your Social Security card needs replacement.
Don’t:
- Give your Medicare Number in exchange for gifts, equipment, or “free” services.
- Accept medical supplies you didn’t request or your doctor didn’t order.
- Respond to pressure tactics, door-to-door sales, or aggressive marketing.
- Assume that TV or online ads are legitimate — many are misleading.
If you think you mistakenly gave your information to someone suspicious, contact the Federal Trade Commission at 1-877-438-4338.
Know the Rules Medicare Plans Must Follow
Not all marketing is legal — and understanding the rules protects you from aggressive or dishonest sales tactics.
Medicare plans cannot:
- Ask for bank account or credit card information over the phone
- Come to your home uninvited
- Offer cash or gifts to enroll
- Enroll you over the phone unless you initiate the call
- Sell you non-health products (like annuities) during a Medicare appointment
- Market to you during educational events
- Use misleading phrases like “Medicare endorses this plan”
If you believe an agent or plan violated these rules, call 1-800-MEDICARE or contact your State Health Insurance Assistance Program (SHIP).
Helpful Resources
These organizations specialize in educating and protecting Medicare beneficiaries — and they’re completely free.
Final Thoughts: Stay Alert, Stay Protected
Medicare fraud prevention doesn’t require special services, just awareness. By reviewing your claims, guarding your personal information, and reporting anything unusual, you can protect yourself from harmful Medicare Fraud.
At Decima Wealth Consulting, we help retirees navigate Medicare, Social Security, and the financial decisions that shape your retirement. If you’d like help reviewing your coverage or identifying potential risks, we’re here to be your trusted guide.
