How do I report Medicare fraud?

Medicare’s help line, 800-633-4227. You can call Medicare directly to ask questions or report fraudulent activity on your Medicare Summary Notice. You may also need to work with Medicare to clear up your record if someone has been making phony charges in your name, which could affect your coverage. See Medicare’s guide to reporting fraud for more information.

U.S. Department of Health & Human Services fraud hotline, 800-447-8477. You can file an online report with the HHS Office of Inspector General, which investigates fraud. You’re not required to identify yourself when reporting a suspected fraud although investigators may want to contact you for further information to pursue the case properly.

Private plans for Medicare Advantage or prescription drugs. If you find suspicious activity on your Medicare Advantage or Part D explanation of benefits, you can contact the plan directly.

You can also report Part D fraud at 877-772-3379. If you suspect you’ve been fraudulently enrolled in a plan or would like to report misleading marketing materials or attempts to enroll people in a Medicare Advantage or Part D plan without their knowledge, contact Medicare or your Senior Medicare Patrol.

State Health Insurance Assistance Program (SHIP). Counselors have technical knowledge about Medicare and often work with local Senior Medical Patrols. Find local SHIPs at www.shiphelp.org or by calling 877-839-2675.  

How can I spot Medicare fraud?

Because Medicare is usually billed for services and you may never see charges or pay money yourself, Medicare fraud can go undetected. Regularly review your Medicare summary notice for any suspicious activity, especially if you see that Medicare paid for a service or item you didn’t receive.

Original Medicare enrollees receive this notice in the mail every three months if Medicare was billed for any services or medical supplies during that period. Typically, it lists Medicare charges billed, what it paid and the maximum amount you may owe a provider. Or you can sign up to receive electronic notices, which you'll receive every month. You can also access claims information in your online Medicare account within 24 hours of when Medicare processes them.

Medicare Advantage and other private plans issue their own explanation of benefits, so review those thoroughly for suspicious activity as well.  

Keep in mind

Easy ways to protect yourself from Medicare fraud:

• Never share or openly display your Medicare number.

• Never give out your Medicare number if someone calls or emails you offering medical equipment and supplies in return for providing your Medicare number.

• Never respond to calls or emails offering to upgrade your card or asking for your Medicare number for other unexpected reasons. You can order or print a replacement Medicare card at any time from your online Medicare account.

Caregivers should also watch for potential Medicare fraud. If you’re helping older parents, ask if you can review their Medicare summary notices and look for charges or services that don’t match appointment dates. Also ask questions about durable medical equipment not ordered, another red flag.  

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