Is Medicare fraud an issue I should be worried about?

Question

Gary Church · Accepted Answer

Have a question? Came in about Medicare fraud. Is that something we should be concerned about? Yes, we should all be concerned about fraud within Medicare, whether that's through a Medicare Advantage plan or billing, or somebody abusing the system to take advantage of it. That affects all of us through our premiums. So yes, we should all be concerned about fraud within Medicare. Hopefully, that answers the question.

Mike Alexander · Answer

Medicare fraud affects all of us. If you see fraud or notice questionable practices Call 800-medicare and report it

Mark Bilgere · Answer

In general Medicare fraud is a concern because it affects the whole system, resulting in higher costs for everybody. At the individual level your greatest concern should be someone using your Medicare number to commit fraud. However this fraud is usually not targeted to the beneficiary, but instead your number is used to make bogus charges for reimbursement.

The best way to help is to keep you Medicare number private. Never give it out over the phone to someone you don't know. Medicare will never call you and ask for your number. Usually you only need to share your number with a new provider or your trusted agent if they are helping you enroll in a new plan or are working with you to resolve an issue with Medicare.

Don't talk to any unsolicited Medicare phone calls.

Shelly Hefley · Answer

YES! Fraud is an issue everyone should be knowledgeable about. Fraud is hitting in every aspect of our society and Medicare is no different. Everyone needs to review their Medicare statements for accuracy. If you notice you’re being charged for things that you’ve never received. You need to call Medicare right away.

Answered by Shelly Hefley on March 30, 2026

Broker Licensed in IN, AL, IL, KY & TN

Answered by Shelly Hefley Medicare Insurance Agent

Edward Wooten · Answer

Always be cautious of fraud and scams. Treat your Medicare number just like your Social Security number. Social Security and Medicare will never call you first, and if something feels off, trust your instincts. Working with your broker or agent can help keep you protected.

Answered by Edward Wooten on December 27, 2025

Broker Licensed in IL & MO

Answered by Edward Wooten Medicare Insurance Agent

Donna Berube · Answer

If you're careful with your Medicare number and protect that like you do your social security card then you should have nothing to worry about. NEVER give your Medicare number over the phone to someone that calls you.

Answered by Donna Berube on March 31, 2026

Agent Licensed in NH

Answered by Donna Berube Medicare Insurance Agent

Mary Green · Answer

Patients using their Medicare for legitimate healthcare reasons can be affected by Medicare fraud in various ways. If your Medicare account is billed for benefits you never received, and it's a benefit that Medicare only approves a certain number of times, you might at some point want or need that specific benefit and Medicare could deny coverage because in their record you've already reached your limit. A doctor could prescribe the wrong medication if your medical records show fraudulent tests with accompanying false diagnoses. Fraudulent costs to the Medicare program makes it more costly to maintain than it actually is, and threatens future Medicare viability as a needed program for the beneficiaries who qualify.

Answered by Mary Green on November 11, 2025

Broker Licensed in AL, CO, FL, GA, TN & VA

Answered by Mary Green Medicare Insurance Agent

Corey Romero · Answer

Unfortunately, yes. And I say that from personal experience.

Someone in my own family had fake charges show up from a bogus company billing Medicare for medical supplies they never needed and never received. It looked official, and unless you’re really paying attention, it’s easy to miss stuff like that.

Fraud is a big business, and seniors are prime targets, especially when their personal info gets out there. We’re talking shady companies billing Medicare for mobility devices, braces, tests... you name it. And most of the time, the person being billed has no idea it’s even happening.

So yeah, it’s a big problem for everyone. It’s easy to think “Medicare’s paying, not me,” but fraud drives up costs for everyone.

The best thing you can do is look over the Medicare summary notices or plan EOBs regularly. If something looks off, say something. You can report it, and in many cases, it gets cleaned up pretty quickly if you catch it early.

Tiffany Gladwell · Answer

Absolutely. To combat fraud my most important suggestion is to not make any changes or agree to anything regarding your coverage without first consulting your personal agent. They are there to help and guide you. Also protect your Medicare number as if it were your social security number.

Answered by Tiffany Gladwell on January 13, 2026

Agent Licensed in NC, SC, TN & VA

Answered by Tiffany Gladwell Medicare Insurance Agent

Harold (Rob) Thousand III · Answer

Everyone should be concerned about Medicare fraud. However, there are definitely misconceptions about it. If you have an agent, bounce it off your agent. Talk to your insurance company if you think there is something strange going on. Every year, agents need to certify that they have taken a fraud, waste and abuse training. It is an important topic that everyone should be concerned about.

Answered by Harold (Rob) Thousand III on January 19, 2026

Agent Licensed in NY, AR, AZ & 18 other states

Answered by Harold (Rob) Thousand III Medicare Insurance Agent

Gary Smith · Answer

Yes, it’s definitely something to be aware of. Medicare fraud is a real problem, costing Americans a lot of money each year.

Scammers know that Medicare is a huge opportunity to take advantage of vulnerable people, so be cautious. The government estimates that Medicare loses tens of billions of dollars each year to fraud, error, and abuse. In 2022 alone, the Department of Justice reported recovering over $1.7 billion in healthcare fraud cases. Seniors are often the main targets because scammers know you rely on your benefits.

What does that fraud look like? Sometimes it involves billing for care you never received. Other times, it’s charging for expensive equipment, like a power wheelchair, when you only received a cane. In some cases, it’s straight-up identity theft—using your Medicare number to file fake claims.

The good news is that most fraud can be caught early if you pay attention. Always check your Medicare Summary Notice or Explanation of Benefits. If you see a doctor visit, test, or piece of equipment you didn’t get, that’s a red flag. And remember—Medicare will never call out of the blue asking for your number or show up at your door.

So yes, it’s worth watching for. But if you treat it like checking your credit card bill—just a quick review—you’ll be ahead of most scammers.

Jeff Tomberlin · Answer

Even though fraud is prevalent, it's not a new concept. You do have to be more alert than ever. Given new technology, scammers are constantly looking for ways to beat the system. With the addition of AI, they have the capability of keeping you on the phone for a short period of time while recording your voice. After doing this, they can manipulate a recording of your voice that sounds exactly like you and use that to enroll you into a program. One that you probably didn't want. I tell my customers; "you know your friends and family's phone numbers. If you recognize it feel safe answering the call. If not, let it go to voicemail. If it's something that's important, the caller will leave a message."

Answered by Jeff Tomberlin on September 18, 2025

Agent Licensed in SC

Answered by Jeff Tomberlin Medicare Insurance Agent

Leslie Santos · Answer

Yes, fraud is the major driver of benefits being cut and you should be concerned because that directly affects your copayments and deductibles.

Lou Ann Pyatt · Answer

Yes.  Make sure you are responding to a trusted agent who you have given permission to contact you; request agent's license number and state of license.
Do not respond to questions from a random caller.

Susan Story · Answer

Medicare fraud is a very real problem and one that everyone should be aware of. It is essentially identity theft by using your information without your consent.

Fred Manas · Answer

You should be concerned and vigilant because perpetrators use tactics like identity theft and fake offers to trick people into providing personal information or accepting unwanted services. To protect yourself, be cautious of unsolicited offers, verify your billing statements, never share your Medicare number with unknown contacts, and report suspected fraud to the Senior Medicare Patrol (SMP) or 1-800-MEDICARE.

Answered by Fred Manas on September 29, 2025

Agent Licensed in NY, CT, DC & 7 other states

Answered by Fred Manas Medicare Insurance Agent

Mary Brown · Answer

Medicare is real and something you should be aware of. 
You can protect yourself by guarding your Medicare number, checking your Medicare Summary and never giving your Medicare number over the phone to people you do not know.

Don Hansford · Answer

We should all be concerned about Medicare fraud, as it costs us, the taxpayer, millions of dollars every year. Be diligent by reviewing all charges on your EOB (explanation of benefits) to be sure nothing looks out of place.

Answered by Don Hansford on September 18, 2025

Broker Licensed in TX

Answered by Don Hansford Medicare Insurance Agent

Charles Borg · Answer

Not very much. If you speak to a reputable person, there should be no problem. Do not speak with anyone who call you or e-mails you.

Michelle Ryan · Answer

When it comes to unauthorized plan changes, YES! There are so many call centers that are not working compliantly. If you happen to answer one of these phone calls and inexplicably say the word "yes" the bad actor on the other end of the line will take that "yes" and use it as consent to enroll you in a plan. The biggest thing to remember about this is that a "Scope of Appointment" (SOA) has to be completed 48 hours before someone, that reached out to you, can market Medicare Plans to you.

Answered by Michelle Ryan on September 26, 2025

Broker Licensed in GA, AL, CO & FL, NC, SC & TN

Answered by Michelle Ryan Medicare Insurance Agent

John Messler · Answer

Absolutely! Do not answer the phone of a stranger. Unsolicited calling is against the law. Whenever you speak to an agent, ask for their NPN number. If they don’t give it end the conversation. If they do, you can verify it. I often recommend using somebody local or a referral from somebody you know and trust. There are more and more advertisements on Facebook and other social media. Don’t click on them.

Answered by John Messler on February 23, 2026

Agent Licensed in NH, ME, NC, OH, PA & TX

Answered by John Messler Medicare Insurance Agent

James Wareheim · Answer

Not normally.  If you are working with a local licensed agent and not calling 800 numbers you should feel comfortable.

Roberto Alonso · Answer

Yes, because ultimately we all pay for it.
 
Next time you review your EOB letter or your annual ENOC letter from your plan, be mindful of what they say. Carefully review your electronic messages from Medicare.gov when you receive services. Do not just assume, be smart and review these documents carefully.

Report any waste, abuse or fraud.

Robert Nunn · Answer

Of course, there is rampant overbilling, incorrect billing, and billing for procedures people don't need. Having a qualified, licensed health agent in your corner is vital. At the bare minimum, ask questions, and on every Medical release you sign for service by your signature, note that you are only authorizing payment for reasonable and customary service .

Answered by Robert Nunn on October 1, 2025

Agent Licensed in FL, AL, AR & 36 other states

Answered by Robert Nunn Medicare Insurance Agent

Peggy Elliott · Answer

Medicare fraud does not seem to affect the clients that I have. In any large association there are always people seeking to profit off of the uninformed public . You just need to always be careful of who you associate with.

Answered by Peggy Elliott on October 13, 2025

Agent Licensed in OH

Answered by Peggy Elliott Medicare Insurance Agent

Stanley Wittenberg · Answer

For the most part no. The problem is with the patients who attempt to take advantage of the system. The physician needs to make sure the patient’s paperwork is properly documented

Larry Plyler · Answer

I think any type of Fraud is serious. Medicare fraud is an issue since it affects everyone on Medicare. That is theft of money that retirees depend on the solvency of funds that are designated for all Medicare receipients.

Answered by Larry Plyler on February 16, 2026

Broker Licensed in SC, NC & TN

Answered by Larry Plyler Medicare Insurance Agent

Gene Page · Answer

This is a question with a dozen answers. Licensed agents are required to study and test regarding this topic. 

The Short answer is, "Yes".

Fraud comes in many forms, from doctors getting referral  kickbacks to those writing fake prescriptions. Pharmacies may be in on the corruption where claims are filled to fulfil false prescriptions.  Billings may occur for services that were never provided. Unnecessary tests may be run to boost billable services.

But the one that will directly impact the member, are illegal outbound phone calls from questionable agencies asking about your coverage and offering you things they feel will persuade you to make a change. They may tell you that a benefit is something "brand new" to your state. They give you the impression that nothing on your plan will change, but they are able to add benefits that you do not currently have. They will tell you that your agent didn't know, or didn't bother to tell you all your options. THIS CALL IS ILLEGAL. Your current policy could be dropped, your medications not covered, your doctors may not be in network, all because they convinced you to get a food card, dental coverage, or a part B refund!  The worst part is they might file a complaint against your agent in order to create a reason to submit the change.

Never allow these illegal calls to continue. If you have questions about your policy or potential benefits, contact your agent to review these potential changes. You may be reminded of the reason you selected the policy you chose. ALWAYS SPEAK WITH SOMEONE THAT YOU TRUST.

Tammy Monjaras · Answer

Medicare fraud does exist. Never give out your Medicare number to someone you don’t know or trust- especially over the phone. Find an agent to work with to advise you on plans that best suite your needs and get to know and trust them.

Answered by Tammy Monjaras on September 19, 2025

Agent Licensed in OH, IN & KY

Answered by Tammy Monjaras Medicare Insurance Agent

Mirian Mercado · Answer

It is a real issue, but you should be aware of it and not afraid of it. The good news is Medicare has systems in place to detect fraud and most suspicious billing is caught and corrected. Beneficiaries are usually not responsible for fraudulent claims if reported properly.

Answered by Mirian Mercado on May 25, 2026

Agent Licensed in RI

Answered by Mirian Mercado Medicare Insurance Agent

Is Medicare fraud an issue I should be worried about?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

Is Medicare fraud an issue I should be worried about?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website