Table of contents

Introduction

How to spot & report Medicare fraud

Protect yourself from identity theft

Protect yourself when dealing with private companies who offer Medicare plans

Additional fraud resources

Tips to help prevent Medicare fraud

The information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users can call 1-877-486-2048.

Introduction

Medicare fraud and medical identity theft can cost taxpayers billions of dollars each year. Medical identity theft is when someone steals or uses your personal information (like your name, Social Security Number, or Medicare Number) to submit fraudulent claims to Medicare and other health insurers without your permission.

Medicare is working to find and prevent fraud and abuse. We’re working more closely with health care providers and improving the way we review Medicare claims for possible billing fraud. Read this booklet to learn how you can help fight and protect yourself from fraud.

How to spot & report Medicare fraud

Protect yourself and Medicare against fraud by reviewing your Medicare claims for errors, looking for other types of fraud, and reporting anything suspicious to Medicare.

Review your Medicare claims for errors

When you get health care services, record the dates on a calendar and save the receipts and statements you get from providers to check for mistakes. Compare this information with the claims Medicare processed to make sure you or Medicare weren’t billed for services or items you didn’t get.

After Medicare processes your Original Medicare claims, you can review them by:

Looking at your “Medicare Summary Notice.”

Visiting MyMedicare.gov.

Calling 1-800-MEDICARE (1-800-633-4227) and using the automated phone system. TTY users can call 1-877-486-2048.

“Medicare Summary Notice” (MSN)

If you have Original Medicare, check your MSN. This notice shows the health care services, supplies, or equipment you got, what you were charged, and how much Medicare paid. If you’re in a Medicare health plan, check the statements you get from your plan.

Review each notice you get to make sure that it’s accurate and that you and Medicare weren’t billed for services or items you didn’t get. If you see a charge that may be wrong, see here to learn how to report it.

MyMedicare.gov

MyMedicare.gov is a free, secure online service that’s available to help you access your personal Medicare-related information 24 hours a day, every day.

You don’t have to wait for your “Medicare Summary Notice” to view your Medicare claims. You can visit MyMedicare.gov to track your Medicare claims or sign up for electronic “Medicare Summary Notices” (eMSNs).

1-800-MEDICARE

You may also get information about your Original Medicare claims that have been processed in the past 12 months through Medicare’s automated phone system. You don’t need to speak to a customer service representative. Just call 1-800-MEDICARE (1-800-633-4227) and provide a few key pieces of information. TTY users can call 1-877-486-2048.

It’s also helpful to understand what Medicare pays for. You can find this information in your “Medicare & You” handbook. If you don’t have a copy, visit Medicare.gov/medicare-and-you or call 1-800-MEDICARE.

Note: If you think a charge is incorrect and you know the provider, you can call his or her office to ask about the charge. Your provider or his or her staff may give you information that helps you better understand the services or supplies you got. Or, they may find an error that needs to be corrected. Correcting a billing error benefits both you and Medicare.

Look for other types of Medicare fraud

Be suspicious of doctors, health care providers, or suppliers that tell you:

The equipment or service is free, it won’t cost you anything, and they only need your Medicare Number for their records

Medicare wants you to have the item or service

They know how to get Medicare to pay for the item or service

The more tests they provide, the cheaper the tests become

Be suspicious of doctors, suppliers, or facilities that:

Don’t charge copayments without checking on your ability to pay

Advertise “free” consultations to people with Medicare

Bill Medicare for services, supplies, or equipment you didn’t get

Put the wrong diagnosis on the claim so Medicare will pay

Bill Medicare for tests you got as a hospital inpatient or within 72 hours of your admission or discharge

Claim they represent Medicare or a branch of the federal government

Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests or threaten to withhold services

Offer you money or kickbacks to use their services, join their plan, or let them use your Medicare Number

Use phone calls and door-to-door selling as marketing tools

Offer non-medical transportation or housekeeping as Medicare approved services

Bill home health services for patients who aren’t confined to their home, or for Medicare patients who still drive a car

Ask you to contact your doctor and ask for a service, supply, or equipment that you don’t need

Bill Medicare for a back-brace or other orthotics, power wheelchair or scooter, or genetic tests when you don’t need one or don’t meet Medicare coverage rules

Report errors and concerns

If you suspect Medicare fraud, do any of these:

Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.

Visit forms.oig.hhs.gov to file a report online.

Before you file a report, carefully review the facts, and have this information ready:

Your name and Medicare Number (as listed on your red, white, and blue Medicare card)

The name of the doctor, supplier, or facility that you think committed fraud. If possible, also include any identifying number you might have, like a provider or supplier number.

If the fraud is related to a specific claim, you should have this information ready:

The service or item you’re questioning

The date the service or item was supposedly given or delivered

The payment amount approved and paid by Medicare

The date on your “Medicare Summary Notice”

The reason you think Medicare shouldn’t have paid

Any other information you have showing why Medicare shouldn’t have paid for a service or item

If the fraud isn’t related to a specific claim, you should have this information ready:

A description of the fraudulent activity

The place, date, and time the incident happened

Any other information or evidence you have showing why you think the incident is fraud

Protect yourself from identity theft

Identity theft is a serious crime that happens when someone uses your personal information without your consent to commit fraud or other crimes. Personal information includes things like your name and your Social Security, Medicare, or credit card numbers.

Here are some things to know about protecting your personal information:

Don’t share your Medicare Number or other personal information with anyone who contacts you by phone, email, or by approaching you in person, unless you’ve given them permission in advance.

Medicare, or someone representing Medicare, will only call and ask for personal information in these situations:

A Medicare health or drug plan can call you if you’re already a member of the plan. The agent who helped you join can also call you.

A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.

Only give personal information like your Medicare Number to doctors, insurers acting on your behalf, or trusted people in the community who work with Medicare like your State Health Insurance Assistance Program (SHIP).

If someone calls you and asks for your Medicare Number or other personal information, hang up and call us at 1-800-MEDICARE.

If you suspect identity theft, or think you gave your personal information to someone you shouldn’t have, call the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338. TTY users can call 1-866-653-4261. Visit consumer.gov/idtheft to learn more about identity theft.

Note: If your Medicare or Social Security card is lost or stolen, or if you need a new card, visit socialsecurity.gov, or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. If you get benefits from the Railroad Retirement Board, visit rrb.gov, or call 1-877-772-5772.

Protect yourself when dealing with private companies who offer Medicare plans

This information will help you when dealing with private companies (approved by Medicare) that offer Medicare health and prescription drug plans.

Understand the type of plan you join

You have options in how you get your health and prescription drug coverage through Medicare. You can join different types of Medicare plans including Medicare Advantage Plans (like HMOs or PPOs) and Medicare Prescription Drug Plans. Medicare has information to help you compare how these different plans work. Visit Medicare.gov or look at your “Medicare & You” handbook for more information.

It’s important that you read and understand documents before you sign them. Review any information you get from a Medicare plan carefully before you join, and ask a friend or family member to explain anything that you don’t understand.

If you still need help, call the plan or 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Know the rules Medicare plans must follow when they try to get you to join a plan

Medicare plans aren’t allowed to:

Ask for your Social Security Number, bank account number, or credit card information over the phone. (However, if you applied for Extra Help paying for Medicare prescription drug coverage, someone from the plan may contact you if any information is missing from your application.)

Come to your home uninvited to sell or endorse any Medicare related product.

Offer you cash to join their plan or give you free meals while marketing to you.

Enroll you in a drug plan over the phone unless you call them.

Steer you into a particular plan.

Communicate incorrect information about their plan type or use inappropriate statements like their plan is “the best” or “highest ranked.”

Ask you for payment over the phone, internet, or in person. The plan must send you a bill.

Call you unless you’re already a member of the plan. If you’re a member, the agent who helped you join can call you.

Sell you a non-health related product, like an annuity or life insurance policy, while trying to sell you a Medicare health or drug plan.

Make an appointment to tell you about their plan unless you agree in writing or through a recorded phone discussion to learn more about the products being discussed. During the appointment, they can only try to sell you the products you agreed to hear about.

Talk to you about their plan in areas where you get health care, like an exam room, hospital patient room, or a pharmacy counter.

Market their plans or enroll you during an educational event, like a health fair or conference.

If plans use independent agents and brokers to sell their plans, they must be licensed by the state, and the plan must tell the state which agents are selling their plans.

Offer an unapproved Medicare plan.

Use false information to mislead you into joining a Medicare plan.

Report plans that don’t follow the rules

If you think a plan isn’t following these rules, you can:

Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Contact your State Health Insurance Assistance Program (SHIP). To get the phone number for your state, visit shiptacenter.org, or call 1-800-MEDICARE.

You can also call 1-800-MEDICARE if:

You think you were enrolled in a Medicare plan without your consent.

You believe a Medicare plan or an insurance agent representing a Medicare plan misled you.

You think a Medicare plan may be breaking the rules.

If you’re in a Medicare Prescription Drug Plan or a Medicare Advantage Plan and you suspect fraud, call our Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).

Additional fraud resources

Contact the Senior Medicare Patrol (SMP). The SMP Program educates and empowers people with Medicare to take an active role in the health care they get, including detecting and preventing health care fraud and abuse. There’s an SMP Program in every state, the District of Columbia, Guam, and Puerto Rico. For more information, or to find your local SMP Program, visit smpresource.org, or call 1-877-808-2468. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Visit Medicare.gov.

Call 1-800-MEDICARE. A customer service representative can answer your questions 24 hours a day, 7 days a week.

Tips to help prevent Medicare fraud

DOs

DO protect your Medicare Number (on your Medicare card) and your Social Security Number (on your Social Security card). Treat your Medicare card like it’s a credit card. Don’t ever give it out except to your doctor or other Medicare provider. Never give your Medicare Number in exchange for free medical equipment or any other free offer. Dishonest providers will use your numbers to get payment for services they never delivered.

DO remember that nothing is ever “free.” Don’t accept offers of money or gifts for free medical care.

DO ask questions. You have a right to know everything about your medical care including the costs billed to Medicare.

DO educate yourself about Medicare. Know your rights, and know what a provider can and can’t bill to Medicare. Read your “Medicare & You” handbook, or visit Medicare.gov to learn more about your rights and different covered services.

DO use a calendar to record all of your doctor’s appointments and what tests or X-rays you got. Then check your Medicare statements carefully to make sure all the details are correct.

DO be wary of providers who tell you that the item or service isn’t usually covered, but they “know how to bill Medicare” so Medicare will pay.

DO make sure you understand how a plan works before you join.

DO always check your pills before you leave the pharmacy to be sure you got the correct medication, including whether it’s a brand or generic and the full amount. If you don’t get your full prescription, report the problem to the pharmacist.

DO report suspected instances of fraud. See here to find out who to call.

DO review your “Medicare Summary Notices” or other statements from your plan for errors. These notices show what services or supplies were billed to Medicare, what Medicare paid, and what you owe. Make sure you and Medicare weren’t billed for health care services or medical supplies and equipment you didn’t get. If you spend time in a hospital, make sure the admission date, discharge date, and diagnosis on your bill are correct.

DON’Ts

DON’T allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.

DON’T contact your doctor to request a service that you don’t need. Don’t let anyone persuade you to see a doctor for care or services you don’t need.

DON’T accept medical supplies from a door-to-door salesman. If someone comes to your door claiming to be from Medicare or Medicaid, remember that Medicare and Medicaid don’t send representatives to your home to sell products or services.

DON’T be influenced by certain media advertising about your health. Many television and radio ads don’t have your best interest at heart.

DON’T give your Medicare card, Medicare Number, Social Security card, or Social Security Number to anyone except your doctor or other Medicare provider.

CMS Accessible Communications

To help ensure people with disabilities have an equal opportunity to participate in our services, activities, programs, and other benefits, we provide communications in accessible formats. The Centers for Medicare & Medicaid Services (CMS) provides free auxiliary aids and services, including information in accessible formats like Braille, large print, data/audio files, relay services and TTY communications. If you request information in an accessible format from CMS, you won’t be disadvantaged by any additional time necessary to provide it. This means you’ll get extra time to take any action if there’s a delay in fulfilling your request.

To request Medicare or Marketplace information in an accessible format you can:

Call us: For Medicare: 1-800-MEDICARE (1-800-633-4227) TTY: 1-877-486-2048.

Email us: altformatrequest@cms.hhs.gov.

Send us a fax: 1-844-530-3676.

Send us a letter:
Centers for Medicare & Medicaid Services
Offices of Hearings and Inquiries (OHI)
7500 Security Boulevard, Mail Stop S1-13-25
Baltimore, MD 21244-1850
Attn: Customer Accessibility Resource Staff

Your request should include your name, phone number, type of information you need (if known), and the mailing address where we should send the materials. We may contact you for additional information.

Note: If you’re enrolled in a Medicare Advantage Plan or Medicare Prescription Drug Plan, contact your plan to request its information in an accessible format. For Medicaid, contact your State or local Medicaid office.

Nondiscrimination Notice

The Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.

You can contact CMS in any of the ways included in this notice if you have any concerns about getting information in a format that you can use.

You may also file a complaint if you think you’ve been subjected to discrimination in a CMS program or activity, including experiencing issues with getting information in an accessible format from any Medicare Advantage Plan, Medicare Prescription Drug Plan, State or local Medicaid office, or Marketplace Qualified Health Plans. There are three ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Online: https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.

By phone: Call 1-800-368-1019. TTY users can call 1-800-537-7697.

In writing: Send information about your complaint to:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850

Official Business
Penalty for Private Use, $300

CMS Publication No. 10111
Revised November 2019

This booklet is available in Spanish. To get a free copy, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Esta publicación está disponible en Español. Para obtener una copia gratis, visite Medicare.gov o llame al 1-800-MEDICARE (1-800-633-4227). Los usuarios de TTY pueden llamar al 1-877-486-2048.

Paid for by the Department of Health & Human Services.