How to protect yourself from Medicare fraud

By Ryan Curran, MD

Special to the Outlook

Every year, Medicare fraud affects consumers and companies across the nation. Estimates say that last year alone, there was over $1 billion in fraudulent Medicare billings. Not only does Medicare fraud inflate the cost of medical care for everyone, but it can also compromise your private medical information, including past Medicare statements, claims, and even confidential items like your social security number.

So, it’s important to take steps to defend yourself from a potential identity thief, especially when it comes to your medical records. First and foremost, protect your confidential information. When opting for a medicare plan, ensure that you look for a reliable and highly rated source to avoid data leaks as well as for additional cybersecurity practices implemented by the service provider. For instance, if you are looking for a medicare supplement plan G, you can explore websites similar to to learn more about the services they provide, along with integrated online medical data management.

Moreover, when discussing your Medicare information – such as a Medicare ID number and Health Plan details – always take precautions to ensure that your personal information is protected. If an identity thief gains access to your Health Plan ID, they can access your physicians, order prescriptions, and even file a health insurance claim. Generally, in countries such as Canada or the UK, even when people have policies from private companies such as GMS Insurance and others, the data is heavily regulated and verified by government-authorized wings like the NHS. This is done to add an extra layer of protection to policyholders’ data and prevent fraud. However, in the USA this extra layer seems to be absent.

Starting in April, the Center for Medicare and Medicaid Services will issue new Medicare ID cards with a unique alphanumeric ID number rather than your social security number, but it’s still important to “guard your card” and keep it safe like you would a credit card or your social security card.

It’s also important to always keep a close eye on your account’s activity to spot anything unusual or incorrect. In addition to reviewing receipts, dates, and billing statements, make sure the details of your Medicare claims correctly match up with the services you received. You can check at or by calling 1-800-MEDICARE.

And don’t overlook the Explanation of Benefits form sent from your insurance company. The form details how much you have been billed for a specific claim, what your insurance covers, and the deductible amount you’re ultimately responsible for. Compare the explanation of benefits to your medical provider’s receipt to detect any discrepancies that could hint toward potential identity theft.

Along with the various benefits of the medical plan, you may need to consider the aspects not covered under the health insurance. In case you ignore such areas, there are high chances that you may end up losing a lot of money. Usually, there are gaps in every health insurance that are not financially covered. If that’s the case with your plan, you may need to subscribe to one of the Medicare Advantage plans listed at (or any similar website).

Nowadays, some Medicare fraud has been linked to companies or individuals offering “free services or products” in exchange for your confidential information, including your Health Plan ID number. Be wary of phone calls or emails that ask for sensitive Medicare information, such as your Medicare ID, as they could be an attempt to steal your identity. Identity thieves may also call or email pretending to be a medical insurance professional in order to obtain your confidential information. If this happens, hang up or don’t reply, then immediately report it to your health insurance provider.

Medicare fraud can complicate your financial well-being, including your insurance record and credit report. It’s crucial to report any suspicious activity as soon as possible to prevent further fraudulent activity.

You can report suspected Medicare fraud to your health insurance company, to the toll-free number at 1-800-MEDICARE, or online to the Office of the Inspector General on the official Medicare website.

Learn more about the steps you should take to report Medicare fraud here.

Ryan Curran, MD is a family medicine physician with Capital Health Plan.