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Medicare & Health Insurance Scams

What Are Medicare and Health Insurance Scams?

In Medicare and health insurance scams, con artists attempt to obtain your Medicare or health insurance number in order to steal your identity and rack up huge health care charges.

While you may not ultimately be responsible for these charges, the activity can increase health care costs and related taxes for you and everyone else.

This is not the only way scammers can use your Medicare or health insurance information to perpetrate fraud, and some ways may impact you even more directly.

Read on to learn how to identify and protect yourself from Medicare scams and other health insurance scams. 

How Medicare and Health Insurance Scams Work

Commonly, these scams are perpetrated over the telephone, but sometimes in person and, even, via email. In all cases, the individual contacting you claims to be from Medicare (or your health insurance company.)

They may even use spoofing technology to mask their identity from your phone’s Caller ID feature. Sometimes, the call may be a robocall prompting you to take action via voice or your touch-tone keypad rather than speaking directly with a live agent. 

Upon contacting you, there are a number of ways these fraudsters may try to steal your health insurance information or your money, such as:

  • Requesting payment for a new Medicare or health insurance card. (Medicare does not charge a fee for new cards, nor do most health insurers.)
  • Threatening to cancel your Medicare or health insurance if you refuse to verify the information on your card. (Once you do, the scammer may tell you the information is inaccurate and order you not to use the card, then go use that information him or herself.)
  • Offering you free medical supplies or equipment or a free health care checkup, all covered by Medicare. (They simply require you to provide your Medicare number or Social Security number to verify coverage for eligibility purposes and a credit card, of course, to cover the costs of shipping and handling.)
  • Claiming that you’re entitled to a refund of premiums or other charges you’ve already paid. (All they need you to do is provide your Medicare number to confirm your identity and your bank account information to process the refund as a direct deposit.)

Once a scammer has your Medicare or health insurance information, he or she may, then, use it to fill prescriptions, file a false claim or sell it on the dark web to other bad actors. 

Red Flags to Look Out For

There are certain actions a fraudster may take that Medicare never would. If the person requesting your health insurance information does any of the following, he or she may be a fraudster:

  • Request your Medicare number or any other personal data (except if you’ve previously given them permission to do so)
  • Call you to sell you something
  • Visit you at home
  • Initiate a call to enroll you (though they can enroll you over the phone if you’ve placed the call)

Similarly, if you ever receive a call from anyone offering you something special, like extreme prescription discounts, who requires you provide them your Medicare number in order to see if you qualify or process your reward, be warned.

That caller may have ulterior motives. 

Tips to Protect Your Information

  • Protect your health information carefully – Guard your Medicare card and health insurance information carefully. Protect it the same way you would your driver’s license or credit cards. 
  • Be aware of scammers tactics – Be aware that scammers may sound extremely friendly, articulate and sympathetic, attempting to lull you into a false sense of trust and security. Some may even provide “proof” of their legitimacy in the form of personal information they already know about you, such as your birthday, full name or mailing address. Be aware that there are many ways these scammers can obtain this information elsewhere before contacting you, so do not be fooled into thinking that, just because they already know something about you, they must be who they say they are. 
  • Ask for a direct number – If you’re ever uncertain about the true identity and legitimacy of a person calling you about a Medicare or health insurance matter, ask for a direct number you can use to call that person back. Often, this alone will frustrate a scammer and cause him or her to hang up.
  • Google the number before calling back – In the rare instance when the caller does oblige and provide you with a direct number to call back, Google the number before you call back to see if it’s a number associated with Medicare or the health insurer from which the caller claimed to be calling. If the number does not show up as an official number of the respective agency or organization, don’t call it back. Instead, call the official number you find online and inquire whether someone from that agency or organization just contacted you. 
  • Check your statements for billing fraud – In addition to taking extreme caution with your personal information over the telephone (or at your front door with a stranger calling,) review your Medicare or health insurance statements carefully as soon as you receive them in order to check for Medicare or health insurance billing fraud. 

If anyone claiming to be from Medicare or your health insurer asks you for money or personal information or threatens to cancel your policy or benefits, hang up immediately and follow the instructions in the next section below to report the incident. 

Be particularly on guard for Medicare scams around Medicare Open Enrollment (MOE) period between October 15 and December 7 every year, as it’s during these times that Medicare scammers are particularly active. 

Summary and Specific Resources

If you suspect that you’ve been the victim of a Medicare or health insurance scam or that a potential scammer has attempted to victimize you, call 1-800-MEDICARE (1-800-633-4227) to report it. In this way, you can help to protect others like yourself from the same threat. 

You can also file consumer complaints regarding the incident with the Federal Trade Commission (FTC) and/or Federal Communications Commission (FCC) as applicable. 

Read more about Medicare fraud on the official Medicare website.

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