Protecting Yourself & 

Medicare from Fraud 

C E N T E R S f o r M E D I C A R E & M E D I C A I D S E R V I C E S 

This booklet explains: 

■ How to protect yourself and 

Medicare from fraud 

■ How to identify and report 

billing errors and concerns 

■ What to do if you suspect 

Medicare fraud 

■ How to protect your personal 

information 

3

Table of contents 

4 Introduction 

5 How to spot & report Medicare fraud 

10 Protect yourself from identity theft 

10 Protect yourself when dealing with 

private companies who offer 

Medicare plans 

13 Additional fraud resources 

14 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 should call 1-877-486-2048.
4

Introduction 

Most doctors, health care providers, suppliers, and private 

companies who work with Medicare are honest, however, some 

aren’t. Individuals, companies, or groups can commit fraud. 

One example of Medicare fraud is when Medicare is billed for 

services or supplies that you never got. Medicare fraud wastes a 

lot of money each year. Fraud results in higher health care costs 

and taxes for everyone. 

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. 
5

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:

1. Looking at your “Medicare Summary Notice.” 

2. Visiting MyMedicare.gov. 

3. Calling 1-800-MEDICARE (1-800-633-4227) and using the 

automated phone system. TTY users should call 1-877-486-2048. 

“Medicare Summary Notice” (MSN) 

If you have Original Medicare, you get a MSN from a company that 

handles bills for Medicare. This notice shows the health care services, 

supplies, or equipment you got, what you were charged, and how 

much Medicare paid. 

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 page 8 to learn how to 

report it. 
6

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 view electronic notices. 

Your claims will generally be available within 24 hours after 

processing. 

1-800-MEDICARE Automated 

Phone System 

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 

should 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 may first want to 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. 
7

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 power wheelchair or scooter when you 

don’t need one or don’t meet Medicare coverage rules
8

Report errors and concerns 

If you suspect Medicare fraud, do any of these:

■ Call 1-800-MEDICARE (1-800-633-4227). TTY users 

should 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 should call 

1-800-377-4950. 

■ Visit forms.oig.hhs.gov/hotlineoperations 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 
9

If the suspicious activity turns out to be fraud, you may be 

eligible for a reward of up to $1,000. 

To be eligible for an incentive reward, all of these conditions 

must be met: 

■ You must report your suspected Medicare fraud, and the 

allegation must be specific, not general. 

■ The suspected Medicare fraud you report must be confirmed 

as potential fraud by the Program Safeguard Contractor, 

the Zone Program Integrity Contractor, or Medicare Drug 

Integrity Contractor (the Medicare contractors responsible 

for investigating potential fraud and abuse) and formally 

referred to the Office of Inspector General for further 

investigation as part of a case. 

■ You aren’t an “excluded individual.” For example, you didn’t 

participate in the fraud offense being reported. Or, there 

isn’t another reward that you qualify for under another 

government program. 

■ The person or organization you’re reporting isn’t already 

under investigation by law enforcement. 

■ Your report leads to the recovery of at least $100 of Medicare 

money. 

The incentive reward can’t exceed 10% of the overpayments 

recovered in the case or $1,000, whichever is less. If multiple 

individuals qualify for a reward, the reward is shared among 

them. If you want to know more about the Incentive Reward 

Program, call 1-800-MEDICARE (1-800-633-4227). TTY users 

should call 1-877-486-2048. 
10

Protect yourself from identity theft 

When someone steals your identity, they could 

use your personal information without your 

consent to commit fraud or other crimes. 

Personal information includes your name, 

Social Security, Medicare, credit card, or bank 

account numbers. Guard your cards, and keep 

your information safe. 

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 should call 1-866-653-4261. 

Visit consumer.gov/idtheft to learn more about identity theft. 

If you’re in danger (for example, if someone is pressuring or 

intimidating you), call your local police department immediately.

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 should 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. 
11

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 should 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.
12

■ 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 should 

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). 
13

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, U.S. Virgin Islands, 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 should 

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. 
14

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. 
15

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 page 8 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 authorized Medicare provider. 
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 August 2015 

To get this booklet in English or Spanish, call 

1-800-MEDICARE (1-800-633-4227). TTY users 

should call 1-877-486-2048. 

Para obtener este folleto español, llame GRATIS al 

1-800-MEDICARE (1-800-633-4227). Los usuarios 

de TTY deben llamar al 1-877-486-2048.