How to spot Medicare fraud
Most Medicare fraud schemes have a common thread: someone you didn't choose has your Medicare number, and they are billing for services you never received or didn't need.
Common scams targeting Washington seniors
- "No cost" braces, genetic tests or medical equipment: Callers or people at public events offer knee or back braces, genetic or cancer screening tests, or other equipment "at no cost" if you give your Medicare number. The item is then billed to Medicare, often at inflated rates, whether or not you needed it.
- Phony Medicare or Social Security calls: The caller claims your number is "suspended" or that you need a new card, and asks you to confirm your number. Medicare says it will never call you to sell you anything, and it asks for personal information by phone only in limited situations.
- Pressure to switch plans: Someone at your door, or a caller you didn't contact, pushes you to switch to a new Medicare Advantage plan. Under CMS rules, agents can't solicit door to door or make unsolicited cold calls, robocalls, text messages or voicemails.
- "You qualify for extra benefits" TV ads: These can be misleading. The benefits advertised may not be offered in your Washington county, or getting them may mean switching plans, changing doctors or losing drug coverage you rely on.
- Identity theft after a data breach: When health care data is exposed, criminals can use Medicare numbers to bill fraudulent claims long afterward, which is why checking your statements matters.
What the Senior Medicare Patrol (SMP) does
Washington's SMP helps Medicare beneficiaries, their families and caregivers prevent, detect and report health care fraud, errors and abuse. SMP programs are funded by the federal Administration for Community Living and run in every state. In Washington, the SMP is run by the Office of the Insurance Commissioner (OIC). It is not law enforcement, and there is no cost to use it.
Report suspected fraud to Washington's SMP through the OIC's online Medicare fraud form, or call the national SMP Resource Center at 1-877-808-2468 to be connected with Washington's SMP.
Read your Medicare Summary Notice (MSN)
Original Medicare mails a Medicare Summary Notice every 4 months if you had services, listing what was billed to your number. Medicare Advantage and Part D plans send an Explanation of Benefits (EOB) that does the same thing. You can also see Original Medicare claims sooner in your Medicare.gov account. Read these. Look for:
- Services or equipment you don't recognize
- Providers you've never seen
- Dates when you weren't at a clinic
- Duplicate charges
If something looks wrong, first call the provider; many are honest billing errors. If the provider can't explain it, call 1-800-MEDICARE or report it to the SMP.
Protect your Medicare number like a credit card
- Never give your Medicare number, Social Security number or banking details over the phone unless you made the call to a number you trust.
- Be skeptical of "no cost" offers tied to your Medicare card.
- Don't let anyone borrow your Medicare card.
- Shred old MSNs, EOBs and pharmacy receipts before recycling.
- Use your Medicare.gov account to track your claims online.
How to report suspected fraud
- Washington SMP (Office of the Insurance Commissioner): online Medicare fraud form, or the national SMP Resource Center at 1-877-808-2468
- Medicare: 1-800-MEDICARE (1-800-633-4227)
- HHS Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477) or online
- Washington State Attorney General Consumer Protection: 1-800-551-4636 (in Washington), for consumer scams
- Washington Office of the Insurance Commissioner: for misconduct by a licensed insurance agent or an insurance company, file a complaint at insurance.wa.gov
- Apple Health (Medicaid) provider fraud: the Health Care Authority's tip line, 1-833-794-2345
The HHS Office of Inspector General accepts tips without your name. More contacts are on our Washington Medicare phone numbers page.
Sources
- Washington Office of the Insurance Commissioner — Report Medicare fraud (Washington State Senior Medicare Patrol)
- SMP Resource Center — Senior Medicare Patrol
- Administration for Community Living — Senior Medicare Patrol
- Medicare.gov — Reporting Medicare fraud and abuse
- Medicare.gov — Medicare Summary Notice
- HHS Office of Inspector General — Report fraud
- eCFR — 42 CFR 422.2264, Beneficiary contact (unsolicited contact and door-to-door rules)
- Washington Attorney General — Consumer issues
- Washington Health Care Authority — Contact Apple Health (reporting Medicaid fraud)
Frequently asked questions
Will Medicare ever call me to ask for my Medicare number?
Medicare says it will never call you to sell you anything or visit your home, and it calls to ask for personal information only in limited situations. If someone calls out of the blue asking you to confirm or provide your Medicare number, treat it as a likely scam. Hang up and call 1-800-MEDICARE (1-800-633-4227) yourself.
If I gave my Medicare number to a scammer, what should I do?
Call 1-800-MEDICARE (1-800-633-4227) to report it, and check your Medicare Summary Notices or plan Explanations of Benefits closely for services you didn't get. You can also report it to the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477).
Are agents allowed to come to my door uninvited?
No. CMS rules for Medicare Advantage and Part D plans prohibit door-to-door solicitation and unsolicited cold calls, robocalls, text messages and voicemails. An agent may call you or meet you at home only if you asked for the contact or started it yourself.
Does using the Senior Medicare Patrol cost anything?
No. The Senior Medicare Patrol helps Medicare beneficiaries, families and caregivers at no cost. In Washington, you can report through the Office of the Insurance Commissioner's online Medicare fraud form at insurance.wa.gov.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
