Understanding and Protecting from Medicare Fraud, Abuse & Scams

Cassidy Clark
Mar 31
3 min read

Medicare fraud and elder financial abuse are real and growing concerns. Every year, scammers target Medicare beneficiaries in an attempt to steal personal information, bill Medicare for services never provided, or pressure individuals into changing plans.

Knowing how these scams work is one of the most powerful ways to protect yourself. If you are ever questioning if something is a scam, contact SGIA Medicare Consultant to help protect your information and coverage.

Why Medicare Beneficiaries Are Targeted

Scammers often target older adults because:

Medicare numbers are valuable and can be used for fraudulent billing
Many beneficiaries are unfamiliar with yearly Medicare changes
Scammers use urgency and confusion to pressure quick decisions

Your Medicare number should be protected like a credit card or Social Security number.

Common Medicare Scams And How They Work

Examples of how scams typically operate:

“Free” Medical Equipment
1. Scammers offer free braces, diabetic supplies, or tests and ask for your Medicare number. They may bill Medicare for expensive items you never received, so be sure never to give out your Medicare number unless it is to a trusted entity.
Threat Calls
1. You may hear: “Your Medicare benefits are expiring” or “Verify your number immediately.” Medicare will never call to demand personal information, and neither will a licensed agent such as the SGIA Benefit Consultants.
Open Enrollment Pressure
1. Scammers may pretend to be Medicare representatives, offering “extra benefits” to switch plans immediately. Don’t feel pressured into quick decisions; be sure to take your time and verify who is calling.
Phishing Emails or Texts
1. Never click links claiming to be from Medicare. Official Medicare communications rarely use email or text for sensitive information. Be sure to check the email that sent the communication.

Protection tips:

Medicare rarely communicates by email or text.
Do not click suspicious links.
Access Medicare information directly through the official Medicare website or with your licensed agent from SGIA Medicare Consulting.

What Is Medicare Fraud?

Fraud includes:

Billing for services you never received
Billing for more expensive services than what was provided
Using your Medicare number to file false claims

Even if you are not directly charged, fraud affects the entire Medicare system and can cause future billing issues under your name.

How to Protect Yourself

Here are proactive steps you can take:

Guard your Medicare card like a credit card or Social Security number
Only share your number with trusted providers and entities
Review your Medicare Summary Notice (Original Medicare) or Explanation of Benefits (Medicare Advantage)
Shred documents with personal information
Be cautious of high-pressure sales tactics

If something feels wrong, pause before responding.

What To Do If You Suspect Fraud

If you notice:

Charges for services you did not receive
Equipment you never requested
Plan changes you did not authorize

You can:

Contact your healthcare provider’s billing office
Call your Medicare plan
Report suspected fraud to Medicare
Contact the Senior Medicare Patrol (SMP) in your state
Contact your SGIA Benefit Consultant to help identify fraud and scams.

Reporting concerns helps protect you and others.

A Note on Financial Abuse

Scams are not always strangers. Sometimes financial abuse occurs through caregivers, acquaintances, or even family members.

Warning signs may include:

Unexplained financial withdrawals
Sudden changes in insurance coverage
Missing billing statements
Someone discouraging you from reviewing your own paperwork

If you feel pressured or uncomfortable about financial decisions, seek advice from a trusted professional or family member.

Medicare fraud and scams are designed to create confusion, urgency, and fear. The best defense is awareness.

Remember:

Medicare will not call you asking for your Medicare number.
There are no surprise “free benefits” that require immediate action.
You always have the right to slow down and verify information.
The agents at SGIA Medicare Consulting are licensed in all 50 states, will never use high-pressure sales tactics with you, are service-based and not sale-based, and will always fight to protect you from fraud, scams, and financial abuse.