10 Medicare and Healthcare Fraud Scams to Watch Out For
Healthcare fraud isn't just about fake claims submitted by criminals—it's also about scams targeting you directly. These schemes are designed to steal your personal information, charge you for services you never received, or trick you into paying for things you don't need.
Medicare beneficiaries are particularly vulnerable, but these scams can target anyone with health insurance. Knowing what to watch for is your best defense.
1. Fake Medicare Cards
How it works: Someone contacts you claiming to be from Medicare, saying you need a new Medicare card or that there's a problem with your current card. They ask for your Medicare number, Social Security number, or banking information to "process" the new card or "fix" the problem.
The truth: Medicare will never call you asking for personal information. If you need a new Medicare card, you can request one through the official Medicare website or by calling the official Medicare number directly (not a number given to you by someone who called you).
Red flags:
- Unsolicited calls about your Medicare card
- Requests for payment to get a Medicare card
- Pressure to provide personal information immediately
2. Free Medical Equipment Scams
How it works: You receive a call offering "free" wheelchairs, braces, or other medical equipment covered by Medicare. They just need your Medicare number to process the order. The equipment either never arrives, or you receive something you don't need—and Medicare gets billed for expensive equipment.
The truth: Medicare doesn't make unsolicited calls about equipment. If you need medical equipment, your doctor must write a prescription and you'll work with an approved supplier.
Red flags:
- Offers of free equipment you didn't request
- Claims that "everyone over 65 qualifies"
- Pressure to provide your Medicare number over the phone
3. Genetic Testing Scams
How it works: Scammers offer "free" genetic testing, often at health fairs or through door-to-door visits. They collect your DNA sample (usually a cheek swab) and bill Medicare thousands of dollars for unnecessary testing. They might claim the test will detect cancer risk or other conditions.
The truth: Genetic testing is only covered by Medicare when ordered by your doctor for specific medical reasons. Random screening at health fairs isn't typically covered—and isn't necessary for most people.
Red flags:
- Offers of free genetic testing without a doctor's order
- Testing offered at shopping malls, health fairs, or door-to-door
- Claims that testing is "required" by Medicare
4. Telehealth Billing Fraud
How it works: After a brief phone call or video chat with a doctor you've never met, you start receiving medical equipment or prescriptions you didn't request. Your insurance is billed for expensive services and equipment based on that brief conversation.
The truth: Legitimate telehealth requires an established doctor-patient relationship and is for actual medical consultations, not as a way to authorize expensive equipment or medications you don't need.
Red flags:
- Unsolicited telehealth appointments
- Immediate prescriptions or equipment orders after a brief call
- "Free" consultations that result in expensive bills
5. Phantom Billing
How it works: You're billed for medical services, tests, or procedures that never happened. Sometimes this is from a provider you've never seen. Other times, it's a provider adding extra services to a legitimate visit.
The truth: You should only be billed for services you actually received. This is why reviewing your Explanation of Benefits (EOB) statements is so important.
Red flags:
- Bills from providers you've never visited
- Dates of service when you weren't at the doctor
- Services or tests you don't remember receiving
6. COVID-19 Related Scams
How it works: These scams evolved during the pandemic but continue today. They include offers of "free" COVID tests requiring your Medicare number, calls about vaccination records, or claims about COVID-related benefits you need to claim.
The truth: COVID tests and vaccines are covered by Medicare without requiring you to provide information to strangers. Legitimate healthcare providers won't call asking for your personal information.
Red flags:
- Unsolicited offers of free COVID tests by mail
- Requests to "verify" your Medicare number for COVID-related services
- Claims about special COVID benefits requiring immediate action
7. Prescription Drug Discount Cards
How it works: Someone offers you a "special" prescription discount card, claiming it will save you money. They might ask for your insurance information or a fee to get the card. Some of these cards are legitimate discount programs, but scammers use them to collect your information or charge fees for cards that don't work.
The truth: Medicare has its own prescription drug program (Part D), and there are legitimate discount programs. But you shouldn't give out your Medicare information to get a discount card, and you shouldn't pay fees for cards.
Red flags:
- High-pressure sales tactics
- Requests for your Medicare or insurance information
- Claims that their card works better than Medicare Part D
- Fees to obtain the card
8. Billing for Dead Patients
How it works: After a family member passes away, you continue to receive medical bills in their name for services supposedly provided after their death.
The truth: This is clear fraud. Healthcare providers sometimes continue billing Medicare for deceased patients, knowing that grieving families might not notice or might pay bills out of habit.
Red flags:
- Medical bills dated after the person's death
- Claims for ongoing treatments for someone who has passed away
9. Medical Identity Theft by Insiders
How it works: Someone with access to medical records—like a healthcare worker, billing staff, or office employee—uses patient information to submit fraudulent claims or sell information to others.
The truth: Most healthcare workers are honest, but insider fraud does happen. This is particularly hard to detect because the billing comes from legitimate healthcare facilities.
Red flags:
- Unexplained claims on your insurance
- Services from departments you didn't visit
- Multiple claims filed on the same date from different providers
10. Health Insurance Marketplace Scams
How it works: During open enrollment periods, scammers pose as marketplace representatives or insurance agents. They offer to "help" you enroll in coverage but actually steal your personal information or sign you up for fake plans.
The truth: Use only official government websites (HealthCare.gov) or work with licensed insurance agents you've researched and verified.
Red flags:
- Unsolicited calls about health insurance enrollment
- Pressure to enroll immediately without time to research
- Requests for payment via gift cards or wire transfer
- Websites that look official but have slightly different URLs
How to Protect Yourself
Review your EOB statements: Look at every Explanation of Benefits from your insurance company. Question anything you don't recognize.
Never give out information to unsolicited callers: If someone calls claiming to be from Medicare or your insurance company, hang up and call the official number yourself.
Be skeptical of "free" offers: If something sounds too good to be true, it probably is.
Shred sensitive documents: Don't just throw away bills, EOBs, or anything with your insurance information.
Report suspicious activity: If you suspect fraud, report it to Medicare (1-800-MEDICARE), your insurance company, and the FTC.
What to Do If You've Been Targeted
If you think you've fallen victim to a healthcare scam:
- Contact your insurance company immediately
- File a report with the Office of Inspector General (OIG) at 1-800-HHS-TIPS
- Place a fraud alert on your credit reports
- Review your medical records for fraudulent entries
- File a report with the Federal Trade Commission
Monitoring for Ongoing Protection
Staying on top of all your medical claims and insurance statements takes constant vigilance. Many families find it helpful to use monitoring services that automatically review claims for suspicious activity.
Services like HealthLock track your medical claims and alert you to potential fraud, billing errors, or identity theft, helping you catch problems before they become serious.
The Bottom Line
Healthcare fraud schemes are becoming more sophisticated, but most follow similar patterns: they pressure you to act quickly, they offer things that seem too good to be true, and they ask for personal information you shouldn't share.
Your Medicare number and insurance information are as valuable as your credit card number. Protect them the same way. Be skeptical of unsolicited offers, review your statements carefully, and report anything suspicious.
Stay Safe from Medical Scams
With over $60 billion in Medicare fraud annually, vigilance is essential. HealthLock monitors your medical claims for suspicious activity, duplicate billing, and identity theft, providing an extra layer of protection against scammers. HealthLock's members have saved over $243 million by catching billing errors, denied claims, and fraud before they became major problems.
Disclaimer: We're not medical billing experts or attorneys—we're patients and caregivers sharing resources to help you navigate a broken system. This information is for educational purposes only and should not be considered medical or legal advice.
Affiliate Disclosure: This site may contain links to services like HealthLock that help monitor medical claims and billing. We may earn a commission if you sign up through our links, at no extra cost to you. We only recommend services we believe can genuinely help.