Medicare Fraud: 5 Steps To Protect Yourself

Medicare fraud can be costly
Medicare fraud can be costly

Medicare fraud can cause you a lot of headaches. It is costly to individuals and to taxpayers – we all pay for this fraudulent activity. Medicare fraud is very lucrative for scammers, otherwise, they would not waste their time on it.

A stolen Medicare card can be a valuable asset in the wrong hands. Scammers can use your Medicare number to bill Medicare for supplies and services in your name. The more funds that are paid out in false claims, the less money there could be available to pay for legitimate benefits for those who need it. This can cause premiums to rise for everyone.

Until April 2018, Medicare would print your Social Security Number (or your spouse’s, depending on your Medicare eligibility) with an extra letter on the Medicare card. However, new legislation changed the law so that Medicare is now issuing random letters and numbers as your new Medicare Beneficiary Identifier (MBI) to replace the old Medicare number. It is 11 characters long.


Five Ways You Can Fight Medicare Fraud

Fraudulent activity increases during the Annual Election Period (AEP), which some call Open Enrollment (Oct. 15 – Dec. 7). But Medicare fraud can hit at any time. Here are five ways you can keep your guard up:

1. Protect Your Medicare Card

Even though your SSN is no longer on your Medicare card, it is still a valuable number that needs to be protected. There are only three situations that require you to give out your MBI from your Medicare card:

  • When applying for Medicare insurance plans, such as Medigap or a Medicare Advantage. In this case, your independent agent and insurance company needs your MBI to ensure correct billing and claims payments.
  • Your doctor or medical provider.
  • Your Medicare supplies provider

2. Do Not Entertain Door-to-Door Salespeople

Unfortunately, we live in a different world than we did 20 to 30 years ago. If someone shows up at your door unannounced offering medical supplies or Medicare plans, you should sense red flags going up. The medical supply or Medicare plan salesman could be after your valuable MBI from your Medicare card. Neither Medicare nor Medicaid send their representatives to your home to solicit plans. An agent selling Medicare Advantage plans can never legally show up to your house unannounced to sell a plan, either. If one does, they should be reported to your state insurance commissioner’s office. This restriction does not apply to those who sell Medigap, or Medicare Supplement plans.

With today’s available technology, you do not have to let a stranger into your house to get Medicare insurance coverage. Independent agencies like Integrity Senior Solutions can help you enroll online or over the phone. Today’s electronic insurance applications are far safer than the paper applications of yesteryear. The applications are completed by your independent agent directly on the carrier’s website through a secure socket connection. So there is no paper to shred or destroy and no chance that important papers get into the wrong hands.

3. Check Your Explanation of Medicare Benefits (EOMB)

Whenever you receive a Medicare service, the Center for Medicare and Medicaid Services sends you an Explanation of Medicare Benefits, or EOMB. Your insurance company may send one, as well. This EOMB statement gives a detailed account of when and how much your providers are paid for services rendered. It’s important to be sure that the information is accurate. If you see something that is incorrect, be sure to report it to Medicare or your insurance provider.

4. Be Wary of Healthcare Freebies

If someone offers a free medical product or service, but then requires your MBI from your Medicare card, just say no! If it were really free, they would have no need to get your Medicare Beneficiary Identifier. This could be an attempt to grab your MBI for Medicare fraud. As we mentioned earlier, your insurance agent or insurance coverage will need your MBI if you are applying for Medicare coverage. Just be sure you a dealing with a legitimate, licensed insurance agent. You can look up the agent’s information on your state insurance commissioner’s website. Just do a Google search for “[your state] insurance commissioner,” replacing [your state] with the state you live in.

5. Watch For Fake Medicare Plans

Scammers may use the Annual Election Period in the fall of each year to try to have you enroll in their phony plans, services, or products. The goal here is to get their hands on your MBI and use it for Medicare fraud. Use the Plan Finder at to verify any plan that is being offered to you. If it’s not listed, it may be illegitimate.


How to Report Fraud

First, check with your provider. It may be a simple misunderstanding or oversight. An incorrect billing code or filing under the wrong patient can happen.

Your independent agent works for you, so get them involved. Agents are trained to spot fraud.

If you still believe that you or Medicare has been billed for a service or supply you did not receive, call the Medicare helpline to report it (1-800-MEDICARE or 1-800-633-4227, TTY 1-877-486-2048, 24 hours a day, seven days a week).

Another great resource is the Senior Medicare Patrol (SMP) office in your state. SMP workers and volunteers can help determine if there has been any fraudulent activity. They have direct communication with governmental Medicare investigators who will look into it for you.



Although Medicare fraud can happen at any time, it seems to be more rampant during the AEP from October 15 through December 7 of each year. Do your part to be diligent to stop this behavior. It will help strengthen Medicare for all of us.

Thank you for sharing!

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