Quick answer: Medicare fraud happens when false claims are billed using your Medicare Number. Check your Medicare Summary Notices for services you didn’t receive, and report anything suspicious to 1-800-MEDICARE (1-800-633-4227).
What Medicare Fraud Looks Like
- Billing for services, equipment, or supplies you never received
- Charging for a more expensive service than what you actually got
- Someone using your Medicare Number to bill for care that was never provided to you
- Continuing to bill for equipment you returned
How to Check for Fraud Yourself
- Keep a personal calendar of the medical services and appointments you actually have
- Save your receipts and statements
- Review your Medicare Summary Notices (MSNs), or log into your account at Medicare.gov, where claims are viewable within 24 hours of processing
- Call your provider directly for an itemized statement if a bill looks unfamiliar — they’re required to provide one within 30 days
Protect Your Medicare Number
Only share your Medicare Number with your doctor, your insurer, a licensed agent, or a trusted program like your State Health Insurance Assistance Program (SHIP). Legitimate Medicare plans generally won’t call you unless you’re already a member, you left them a message, or you filed a report and someone is following up. Unsolicited calls, emails, or in-person visits asking for your Medicare Number are a red flag.
How to Report Suspected Fraud
| Situation | Who to contact |
|---|---|
| General suspected fraud or misuse of your Medicare Number | 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048 |
| Fraud specific to a Medicare Advantage or Part D plan | Investigations Medicare Drug Integrity Contractor: 1-877-7SAFERX (1-877-772-3379) |
| Personalized help and advocacy | Senior Medicare Patrol (SMP): smpresource.org or 1-877-808-2468 |
| Unresolved complaints about Medicare itself | Medicare Beneficiary Ombudsman, via 1-800-MEDICARE |
Before You Accuse Anyone
Billing errors do happen. Give your provider a chance to explain an unfamiliar charge before assuming fraud — but if the same kind of “error” keeps happening, it’s worth reporting.
Frequently Asked Questions
Can a Medicare plan really call me out of the blue?
Generally no. Plans and agents can’t enroll you over the phone unless you called first or gave prior permission, and they can’t ask for personal information unsolicited. Report violations to 1-800-MEDICARE.
What if I’m not sure whether something is fraud or just a billing mistake?
Call your provider first for an itemized explanation. If it still doesn’t add up, or keeps happening, report it — 1-800-MEDICARE can help sort out genuine errors from fraud.
Is there a group that helps seniors specifically with this?
Yes, the Senior Medicare Patrol (SMP) at smpresource.org or 1-877-808-2468 specifically helps Medicare beneficiaries detect, prevent, and report fraud.
