Medicare fraud, errors, and abuse can affect anyone. Knowing what to look for can help protect your personal information, your Medicare benefits, and the healthcare system as a whole.
From phone scams and misleading marketing to billing mistakes and unauthorized charges, understanding the warning signs can help you protect yourself and take action when something doesn’t seem right.
Understanding Fraud, Errors, and Abuse
Not every issue involving Medicare is fraud. Some situations may be the result of billing mistakes or administrative errors, while others may involve practices that lead to unnecessary Medicare costs. Understanding the difference can help you identify potential issues and take appropriate action.
Fraud is the intentional act of deceiving or misrepresenting information for financial gain.
Errors are unintentional mistakes, such as incorrect billing codes, duplicate charges, or clerical mistakes.
Abuse involves practices that result in unnecessary Medicare costs, such as billing for services that aren’t medically necessary.
Common Warning Signs
While not every unusual charge or billing issue is fraud, there are some warning signs that deserve a closer look. You may want to ask questions if:
•You are billed more than once for the same service.
• You see a charge for a service, test, or piece of equipment you did not receive.
• A provider bills Medicare for services that were not ordered by your doctor.
• Someone asks for your Medicare number in exchange for a free service, gift, or item.
• You receive an unsolicited call, email, or visit from someone claiming to represent Medicare.
• You feel pressured to make a quick decision about a Medicare plan, service, or benefit.
• You notice charges or services that don’t match your records.
How To Protect Yourself
• Treat your Medicare number like a credit card number and only share it with trusted health care providers and organizations.
• Review your Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs) for unfamiliar charges or services.
• Keep records of doctor visits, tests, services, and medical equipment you receive.
• Be cautious of unsolicited phone calls, emails, text messages, or visits claiming to be from Medicare.
• Never sign blank medical or insurance forms.
• Ask questions if you don’t understand a charge, service, or bill.
• Be wary of offers for free services, equipment, or gifts in exchange for your Medicare number.
What To Do If Something Doesn’t Seem Right
Contact your health care provider if you have questions about a charge, service, or piece of medical equipment. In some cases, the issue may be the result of a billing error or misunderstanding.
Contact the company that issued the bill if your provider is unable to answer your questions. Contact information can often be found on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).
Contact your local Senior Medicare Patrol (SMP) if you still have concerns or would like assistance understanding whether an issue may involve fraud, errors, or abuse. SMP staff and volunteers provide education, answer questions, assist with addressing concerns, and help people report suspected fraud when appropriate.
National SMP Resource Center
Phone: 877-808-2468
Michigan SMP
Phone: 877-808-2468
Need Help With Medicare?
MiGen’s MI Options counselors provide free, affirming unbiased Medicare counseling to help Michigan residents understand their coverage, benefits, and options. If you have questions about a Medicare bill, notice a charge that doesn’t seem right, or aren’t sure what steps to take, MI Options counselors can help you understand your options and identify next steps.
Phone: (313) 241-8994
Email: mioptions@migenconnect.org
This project is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $10,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.