From your experience working with Medicare beneficiaries, what are the biggest warning signs that a doctor or healthcare provider may be involved in Medicare fraud, and what should beneficiaries do to protect themselves?

Question

Caroline Johnson · Accepted Answer

Most of the fraud I see doesn't start in a doctor's office. It starts with a phone call or a "free" offer. Here are the red flags I tell my clients to watch for:

Warning signs:

Free things in exchange for your Medicare number. Free braces, diabetic supplies, genetic tests, COVID tests, gift cards. If something is "free with Medicare," be suspicious.
Unsolicited calls, texts, or visits from anyone saying they're "from Medicare." Medicare won't call you out of the blue to ask for your number or sell you something.
Cheek swabs or screenings at health fairs, senior centers, or your front door, especially genetic or cancer tests your own doctor didn't order.
Supplies or equipment showing up that you never asked for.
Pressure to get tests or services you don't think you need, or being told Medicare "requires" them.
A provider who routinely waives your copays or says you'll never owe anything.
Charges on your statements for things you didn't get: visits that didn't happen, equipment you never received, or doctors you've never seen.

How to protect yourself:

Guard your Medicare number like a credit card. Only give it to doctors, pharmacies, and plans you trust.
Read your Medicare Summary Notice or Explanation of Benefits every time. You can also check claims anytime with a free Medicare.gov account.
Keep a simple log of appointments, tests, and supplies so you have something to compare against.
Hang up on anyone pressuring you. Call your doctor, your plan, or your agent directly to check before you agree to anything.
Don't accept anything you didn't order. Refuse the delivery or send it back, and report it.

Where to report it:

1-800-MEDICARE (1-800-633-4227)
HHS Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477) or oig.hhs.gov
Senior Medicare Patrol: 1-877-808-2468. They're free, local, and very good at helping people work through suspicious charges.

Reporting doesn't cost you your coverage. It protects you, and it protects Medicare for everyone else too.

Wade Shiu · Answer

In my experience as a pharmacist and as a Medicare agent...

The Biggest red flags are when: 
1.  a provider bills for visits or tests you never had
2. offers "free" services but asks for your Medicare number first
3. pressures you to sign blank forms
4. or goes door-to-door pushing freebies for your card info.

Protect yourself like this: treat your Medicare number LIKE your Social Security number — don't hand it out for free gifts. Read your Medicare Summary Notices and flag anything you don't recognize.  If something seems off, call 1-800-MEDICARE or your state's Senior Medicare Patrol. They investigate this stuff for a living.

Jeremy Harkins · Answer

One unexpected charge does not automatically mean fraud. Billing mistakes happen. But there are a few warning signs worth paying attention to.

A big one is seeing a service, test or piece of medical equipment on your Medicare statement that you never received. I would also question repeated charges for the same service, equipment your doctor never ordered, or a bill that describes more care than you remember receiving.

Be especially careful if someone contacts you unexpectedly offering “free” braces, medical equipment, genetic testing or other services in exchange for your Medicare number. Someone may be planning to bill Medicare after getting your information.

The best protection is to actually read your Medicare Summary Notice or Medicare Advantage Explanation of Benefits. Ask yourself: Did I see that doctor? Did I receive that test? Did my doctor order that equipment?

If something looks wrong, call the provider’s billing office first. It may be a coding or billing error that can be corrected.

If the explanation still does not make sense, call Medicare at 1-800-MEDICARE (1-800-633-4227) or contact the Senior Medicare Patrol at 1-877-808-2468 for help.

And protect your Medicare number like you would a credit card. Pay attention, ask questions, and report anything that truly does not add up.

Yulonda Clark · Answer

Pushing tests or equipment you don't need. As a nurse, I know care should match your condition. If a provider keeps pushing scans, tests, or a power wheelchair you don't need, ask why. Calls, texts, or door knocks out of nowhere. Medicare doesn't call you asking for your Medicare number. A good doctor's office isn't calling to sell you equipment you never asked for. Thirty-five years in nursing taught me that most providers are good people. It only takes one bad one to steal your benefits, though. I want my clients to know what to look for so they're never the ones caught off guard.

Answered by Yulonda Clark on October 1, 2026

Agent Licensed in IL, AZ, GA, IN & TX

Answered by Yulonda Clark Medicare Insurance Agent

Randy Bridges · Answer

Check online reviews of healthcare providers. Your plan provider may also provide member reviews of participating providers. If your explanation of benefits statements include services or supplies that you did not receive, report this to your plan provider or to Medicare itself.

If you receive medical supplies that your provider did not order or that you do not need, also report this.

Hector Leguillow · Answer

If you get a bill for treatment or services not provided, you should report it to Medicare. 
Always review your notice of coverage even if you don't have a bill to pay.

From your experience working with Medicare beneficiaries, what are the biggest warning signs that a doctor or healthcare provider may be involved in Medicare fraud, and what should beneficiaries do to protect themselves?

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From your experience working with Medicare beneficiaries, what are the biggest warning signs that a doctor or healthcare provider may be involved in Medicare fraud, and what should beneficiaries do to protect themselves?

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