JASMA

Medicare is one of those grown-up systems that’s both incredibly helpful andunfortunatelyirresistible to scammers.
When people talk about “Medicare abuse” and “Medicare fraud,” they’re talking about the same ugly goal: getting paid
(or getting your personal info) through deception, pressure tactics, or billing games. The good news: you don’t need a
detective badge to protect yourself. You just need a few habits, a little skepticism, and the willingness to ask,
“Wait… did I actually get that knee brace?”

This guide breaks down what Medicare fraud and abuse look like in real life, why it matters, how to spot red flags,
what to do if you suspect something, and how to report it fastwithout turning your day into a paperwork marathon.

Medicare Fraud vs. Medicare Abuse (Yes, There’s a Difference)

Think of Medicare fraud as intentional deceptionsomeone knowingly submitting false claims, lying to get paid,
or paying/receiving kickbacks for referrals. Medicare abuse is often “less obviously criminal” on the surface,
but still harmful: practices that lead to unnecessary costs, medically unnecessary services, or billing that doesn’t meet
accepted standards.

Common examples of Medicare fraud

• Billing for services or supplies you never received (“phantom billing”).
• Falsifying records to make it look like something was provided.
• Ordering or billing for medically unnecessary tests or equipment.
• Kickbacks or bribes tied to referrals (money or “rewards” for sending patients somewhere).
• Upcoding: billing a more complex (more expensive) service than what actually happened.

Common examples of Medicare abuse

• Billing for medically unnecessary services.
• Charging excessively for services or supplies.
• Misusing billing codes (including upcoding or unbundling).
• Ordering “extra” tests that aren’t clinically needed.

For you as a beneficiary (or caregiver), the takeaway is simple: whether it’s fraud or abuse, you’re still the one stuck
cleaning up the messconfusing statements, wasted time, and potential identity theft.

Why Medicare Fraud Is a Big Deal (Beyond the Dollars)

Fraud isn’t just “someone else’s problem” or “the government’s problem.” It can affect your life directly. Fake claims can
pollute your medical history, trigger billing disputes, and sometimes push you toward services you don’t need. In large
enforcement actions, federal agencies describe fraud schemes that prey on vulnerable people, including the elderly and
those in hospice care, to generate massive claims for unnecessary or unwanted products and treatments.

And yes, the money is enormous. In a nationwide healthcare fraud takedown announced in June 2025, the U.S. Department of
Justice described cases involving billions in alleged fraudulent charges, including schemes that used deceptive marketing
and unlawfully obtained beneficiary information to generate false Medicare claims. That scale is exactly why scammers keep
showing uplike mosquitoes at a barbecue.

The Most Common Medicare Fraud Schemes (What Scammers Love to Try)

1) “Free” medical equipment that isn’t free at all

If someone offers you a “no-cost” back brace, knee brace, wheelchair, or other durable medical equipment (DME) and asks
for your Medicare number to “process the claim,” be suspicious. Often, the goal is to bill Medicare for expensive items
you didn’t request or need, or to use your number for future claims.

2) Genetic testing and telehealth pitches

One common pattern: a call or ad promises “free genetic testing,” “cancer screening,” or a telehealth visit, then asks for
your Medicare number. The scammer’s payday comes from billing Medicare for tests ordered without a legitimate clinical need
or without proper physician involvement. If your own doctor didn’t recommend it, slow down.

3) Medicare card and “new card” scams

Medicare does not call you out of nowhere to “activate,” “upgrade,” or “replace” your cardespecially not in exchange
for a fee. If someone contacts you unexpectedly and says they need your Medicare number to send a new card, that’s a giant,
blinking red flag.

4) Open enrollment impersonators and caller ID spoofing

Scammers often pretend to be “from Medicare” or “connected to Medicare” during open enrollment season, when people are
making coverage decisions. They may pressure you to “confirm” your Medicare number, bank details, or Social Security number.
They can also fake caller ID so it looks official. Don’t trust the name on your screenverify using official channels.

5) “Flex card” ads and benefit bait

You might see ads claiming Medicare is giving out a “flex card” loaded with money for groceries or bills. Some private plans
offer limited benefits, but scammers use the concept to harvest personal information or trick people into switching plans.
Any claim that “Medicare is issuing flex cards” is a warning sign.

6) Billing games: unbundling, upcoding, and unnecessary services

Not all fraud looks like a sketchy phone call. Sometimes it’s in the paperwork: a provider bills separately for services
that should be grouped together (unbundling), bills a more expensive code (upcoding), or orders tests that aren’t medically
necessary. You may only spot it by reviewing your statements carefully.

Red Flags That Deserve Your Attention (Even If You Hate Drama)

• You’re billed for something you never receivedor received on a date you weren’t even there.
• You get medical equipment you didn’t request (especially braces or testing kits).
• Someone offers money, gifts, or “rewards” in exchange for your Medicare number.
• A caller threatens to cancel coverage unless you act immediately.
• You’re pushed to join or switch a plan over the phone when you didn’t initiate the call.
• You’re asked for bank account or credit card details “to send a new Medicare card.”
• Your explanation sounds like a movie plot: “We need this today, secretly, and don’t tell anyone.”

Your Best Defense: Make Medicare Statements Boring Again

The simplest anti-fraud strategy is also the least glamorous: keep basic records and review your claims. Medicare even
publishes a straightforward routine often summarized as “record, review, report, remember.” The goal is to catch strange
items earlybefore a bad claim turns into a bigger identity problem.

Step 1: Record what you actually received

Put appointments, procedures, and equipment deliveries on a calendar (paper or digitalboth count). Save receipts and any
visit summaries you get. You’re not building a scrapbook; you’re building a reality check.

Step 2: Review your Medicare statements

If you have Original Medicare, pay attention to your Medicare Summary Notice (MSN). It’s not a billit’s a
notice showing what providers billed, what Medicare paid, and what you may owe. Many people receive it regularly, and you
can also choose electronic notices if you prefer.

If you have Medicare Advantage (Part C) or a drug plan (Part D), you’ll typically get an Explanation of Benefits (EOB) or
similar plan statement. The same rule applies: compare what’s listed to what actually happened.

Step 3: Call to “rule out error” first

Sometimes it’s a billing mistake, not a scheme. If you see a charge that looks wrong, call the provider’s billing office
or the plan and ask for an explanation. Take notes (date, who you spoke with, what they said). If the explanation is
fuzzy, defensive, or doesn’t add up, escalate.

Step 4: Protect your Medicare number like a credit card

• Don’t share your Medicare number with unsolicited callers, texts, emails, or door-to-door “helpers.”
• Only give it to trusted providers, insurers acting on your behalf, or legitimate Medicare support resources.
• Don’t accept “free” offers that require your Medicare number to unlock the deal.
• If you suspect your number was stolen, act quicklyfraud moves fast.

What to Do If You Suspect Medicare Fraud (A Calm, Practical Plan)

If your gut says, “This is weird,” listen. Here’s a clean action checklist that doesn’t require panic, just momentum:

1) Gather the basics

• Your Medicare card or Medicare number (keep it privateshare only when reporting through official channels).
• The provider/supplier name and any identifying details you have.
• The date of service, the item/service in question, and the amount billed/paid (from the MSN/EOB).
• Notes about what happened (calls, mailers, unexpected deliveries, promises made).

2) Report it through official channels

Use one (or more) of these trusted reporting options, depending on your situation:

• Medicare: Call 1-800-MEDICARE (1-800-633-4227) if you suspect fraud or abuse, or if you
  think someone is using your Medicare number.
• HHS Office of Inspector General (OIG): Report suspected fraud to the OIG Hotline at
  1-800-HHS-TIPS (1-800-447-8477) or submit a complaint online through the official OIG portal.
• Senior Medicare Patrol (SMP): Get help reviewing suspicious charges and reporting schemes. You can reach
  the SMP at 1-877-808-2468 and they can guide you without you having to “figure out the system” alone.
• If you have a Medicare drug plan or Medicare Advantage plan: You can also contact the Investigations
  Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379).

3) If you shared personal info, treat it like an identity theft incident

If you gave your Medicare number (or other sensitive info) to someone you shouldn’t have, don’t beat yourself upjust act.
Contact Medicare, document what happened, and consider reporting identity theft through official FTC resources (the FTC’s
identity theft hotline is commonly used for guidance). Monitor your accounts, watch for unexpected bills, and keep an eye
on future MSNs/EOBs for suspicious activity.

How Caregivers Can Help (Without Becoming the Family’s Fraud Department)

If you help a parent, grandparent, or another loved one, you can reduce risk without turning into a full-time auditor:

• Set a monthly “statement minute”: review MSNs/EOBs together over coffee. Keep it short and consistent.
• Use a call-back rule: if someone calls about Medicare, hang up and call the official number yourself.
• Create a simple folder system: “Appointments,” “Statements,” and “Weird Stuff.” The last one is important.
• Talk about the top scams: “new card,” “free braces,” “flex card,” and “plan switching pressure.” Repetition helps.
• Encourage reporting: scammers thrive when people feel embarrassed. Reporting helps stop repeats.

Prevention Tips That Actually Work in the Real World

Practice healthy skepticism

If someone contacts you unexpectedly and asks for personal infoassume it’s a scam until proven otherwise. Real Medicare
help doesn’t require urgency, secrecy, or gift cards.

Use official contact info (not what the caller provides)

If you think a call might be legitimate, hang up and call Medicare at 1-800-MEDICARE using a number you
trust (like your card or the official Medicare site). Caller ID can be faked.

Be cautious with “free” offers

“Free” is a favorite scam flavor. If someone offers free medical care or equipment and asks for your Medicare number,
that’s a classic setup for billing fraud.

Check claims sooner, not later

The sooner you spot an error or suspicious claim, the easier it is to correct and report. If you use online access to
review claims, you can sometimes see processed claims earlier than waiting for paper mail.

Real-World Experiences (Common Scenarios and What People Did Next)

The stories below are composite scenarios based on common patterns reported by consumer protection groups and Medicare
fraud prevention programs. They’re not meant to scare youjust to make the red flags feel obvious when they show up in
real life.

Experience #1: The “free back brace” call that turned into a billing surprise

A beneficiary got a friendly phone call: “You qualify for a free back brace at no cost!” The caller asked for the Medicare
number to “confirm eligibility.” A few weeks later, a brace arrived that wasn’t requestedand later the person noticed a
claim for medical equipment they didn’t discuss with their doctor. What worked: they compared the claim to their calendar,
called the supplier to ask for details, then reported the suspicious activity through official channels and asked Medicare
for guidance on protecting their number going forward. Lesson: “free” plus “read me your Medicare number” is not a deal;
it’s a trap.

Experience #2: The open enrollment “Medicare representative” with the perfect caller ID

During open enrollment season, someone called claiming to be from Medicare. The caller ID even displayed something that
looked official. The caller said, “We need to verify your Medicare number to send your updated card.” The beneficiary felt
pressured, but paused and used the call-back rule: hung up and called Medicare directly using the official number. Medicare
confirmed they did not initiate the call. The beneficiary avoided sharing information and later reported the impersonation.
Lesson: caller ID is not proof. Verification is.

Experience #3: The “genetic test kit” that showed up like an unwanted subscription box

A test kit arrived in the mail with paperwork implying it was authorized. The person didn’t remember asking for it, and
their doctor hadn’t ordered it. They refused to use it and contacted their doctor’s office to confirm no legitimate order
existed. Then they reviewed their next statement closely for related charges. Lesson: if your doctor didn’t order it, don’t
assume it’s real just because it looks medical.

Experience #4: The “flex card” ad that asked for too much

A beneficiary saw an ad promising a flex card loaded with money for groceries and utilities. The application page asked
for Social Security and Medicare numbers. They stopped, researched independently, and learned that Medicare itself doesn’t
issue “flex cards,” and that some benefits are plan-specific with eligibility requirements. They decided to talk to a trusted
Medicare counseling resource instead of using the ad. Lesson: benefits bait often leads to identity bait.

Experience #5: The confusing statement that turned out to be “upcoding”

A caregiver reviewing an MSN noticed a visit billed at a higher complexity than what the patient described. The caregiver
called the provider’s billing office and asked for a plain-English explanation of the code and documentation. The office
corrected the claim after realizing the coding didn’t match the note. Lesson: not every problem is a scam, but every problem
deserves a question.

Experience #6: The “threat to cancel coverage” pressure tactic

Someone received a call claiming their coverage would be terminated unless they “verified details immediately.” The caller
tried to keep them on the phone and discouraged them from calling anyone else. The beneficiary ended the call and contacted
Medicare and their plan directly using trusted numbers. Lesson: real organizations don’t need secrecy and panic to do routine
account work.

The common thread in all these experiences is simple: the people who avoided harm didn’t “outsmart” scammers with clever
comebacks. They used boring, reliable habitsrecord, review, verify, and report.

Conclusion: Protect Your Benefits Without Living in Fear

Medicare fraud and abuse thrive on two things: confusion and silence. The antidote is clarity and quick action. Keep a
basic record of care you actually received, review your MSNs/EOBs like you’re checking a bank statement, and treat unsolicited
requests for your Medicare number as suspicious. If something feels off, ask questions, verify through official channels,
and report it. Your benefitsand your peace of mindare worth more than any “free” brace a stranger promises over the phone.