CENTERS FOR MEDICARE & MEDICAID SERVICES

Protecting Medicare

and You from Fraud

★ how to protect yourself and 

Medicare from fraud,

★ how to identify and report 

errors and concerns,

★ what to do if you suspect 

Medicare fraud, and

★ how to protect your 

personal information.

Read this booklet to learn
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What you can do to protect against fraud . . 2–5

Watch spending in Medicare . . . . . . . . 2–4

Protect yourself from identity theft 

and fraud . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Medicare prescription drug coverage . . . . . . . 6

What might make you suspect fraud . . . . . . . . 7

Fraud prevention tips . . . . . . . . . . . . . . . . . . . . 8

What else you should know about fraud . . . . 9

Table of Contents

This booklet tells you about Medicare fraud. It isn’t a legal document.

The official Medicare provisions are contained in relevant laws,

regulations, and rulings.
Introduction 1

Most doctors, health care providers, and private companies who work

with Medicare are honest. There are a few who aren’t honest. Medicare

is working with other government agencies to protect the Medicare

Program from fraud and to fight against identity theft.

Medicare fraud takes a lot of money every year from the Medicare

Program. You pay for it with higher health care costs. Fraud schemes

may be carried out by individuals, companies, or groups of individuals.

The following are examples of possible Medicare fraud:

• Medicare is billed for services or items you never got

• Medicare is billed for services or equipment different from what

you got

• Someone uses another person’s Medicare card to get medical care,

supplies or equipment

• Someone bills Medicare for home medical equipment after it has

been returned

• A company offers a Medicare drug plan that hasn’t been approved

by Medicare

In addition to watching for Medicare fraud, you should also protect

yourself from identity theft. Identity theft happens when an individual

uses your personal information without your consent to commit fraud

or other crimes. See page 5 for more information on how to protect

your personal information.
2 What you can do to protect against fraud

Watch spending in Medicare

When you get health care in the Original Medicare Plan, you get a

Medicare Summary Notice (MSN) from a company that handles bills

for Medicare. Medicare Administrative Contractors* handle your

Medicare Part A and Part B bills. The MSN shows what was charged

for services or supplies and how much Medicare paid.

You should check your MSN for mistakes. Make sure that

Medicare wasn’t charged for any services or supplies that

you didn’t get. If you see a charge on your MSN that may

be wrong, call the health care provider and ask about it.

The MSN may be correct, and the person you speak to

may help you to better understand the services or supplies

you got. Or, you may have discovered an error in billing

that needs to be corrected. This helps both you and the

Medicare Program. There may be rare times when you will

suspect fraud.

How to report errors and concerns

If you aren’t satisfied after speaking to the provider, you should 

• call or write the Medicare Administrative Contractor that sent you

the MSN. Their name, address, and phone number is printed on

the front of the notice, or 

• call the Inspector General’s hotline to report suspected Medicare

fraud. The hotline number is 1-800-HHS-TIPS (1-800-447-8477),

or

• send a note to hhstips@oig.hhs.gov by e-mail. 

Medicare will not use your name if you ask that it not be used.

Note:

* Medicare Administrative Contractors will gradually take over all

Medicare Part A and Part B billing. In some areas of the country,

Medicare Part A bills may still be processed by Fiscal Intermediaries and

Part B bills may still be processed by Carriers.
What you can do to protect against fraud 3

Watch spending in Medicare (continued)

Before you call the provider, the Medicare

Administrative Contractor, or the Inspector General’s

hotline, carefully review the facts, and have the

following information ready:

1. The provider’s name and any identifying number you may have

2. The service or item you are questioning

3. The date the service or item was supposedly given or delivered

4. The payment amount approved and paid by Medicare

5. The date on your Medicare Summary Notice

6. Your name and Medicare number (as listed on your 

Medicare card)

7. The reason you think Medicare should not have paid

8. Any other information you may have showing why Medicare

should not have paid for a service or item

If your suspicion turns out to be fraud, you may be

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

To be eligible for a reward, all of the following conditions must be met:

• You report your suspicion

• Your suspicion is referred to the Inspector General’s office for

review

• Your report leads directly to the recovery of at least $100 

of Medicare money

• The fraud and abuse you report isn’t already being investigated

If you want to know more about this reward program, call your Medicare

Administrative Contractor. You can also call 1-800-MEDICARE

(1-800-633-4227). TTY users should call 1-877-486-2048.
4 What you can do to protect against fraud

Watch spending in Medicare (continued)

You can help protect Medicare by

• reviewing your MSN each time you get it, and asking

questions about any items that you don’t understand.

• learning more about what Medicare will, and will not, pay for. 

You will find this information in the “Medicare & You”

handbook. If you don’t have a copy, call 1-800-MEDICARE

(1-800-633-4227) and ask for a copy. TTY users should call

1-877-486-2048. You can also read or print a copy at

www.medicare.gov on the web.

• making sure Medicare was not billed for health care services or

medical supplies and equipment you didn’t get.

• not giving your Medicare number (on your Medicare card) to

anyone, except your doctor or other Medicare health

professionals.* You should not send these numbers over the

web, unless you are enrolling in a Medicare drug plan or using

the Medicare Prescription Drug Plan Finder on

www.medicare.gov, or sending an e-mail to HHS Tips (see

page 2).

Note:

* You may need to give your Medicare number if you call your

Medicare Administrative Contractor, or the Inspector General’s

Hotline to report errors or concerns.

Use this 3-Step approach if you suspect fraud:

1. Call your health care provider

2. Call your Medicare Administrative Contractor

3. Call the Inspector General’s hotline
What you can do to protect against fraud 5

Protect yourself from identity theft and fraud

Identity theft happens when someone uses your personal information,

like your name; Social Security, Medicare, or credit card number; or

other personal information, without your consent, to commit fraud or 

other crimes.

Keep this information safe. Don’t give your information to

anyone who comes to your home (or calls you) uninvited

selling Medicare-related products. Only give personal

information to doctors or other providers that are

approved by Medicare and to people in the community

who work with Medicare, like your State Health

Insurance Assistance Program or Social Security.

Call 1-800-MEDICARE if you aren’t sure if a provider is

approved by Medicare.

If you think someone is using your personal information, call

• 1-800-MEDICARE (1-800-633-4227). TTY users should call

1-877-486-2048, or

• the Fraud Hotline of the HHS Office of the Inspector General at

1-800-447-8477. TTY users should call 1-800-377-4950, or

• the Federal Trade Commission’s ID Theft Hotline at

1-877-438-4338 to make a report (TTY users should call

1-866-653-4261). For more information about identity theft, 

visit www.consumer.gov/idtheft on the web.

Note:

If you lose your Medicare card or it is stolen, or if you need a new

Social Security card, go to www.socialsecurity.gov on the web, or call

Social Security at 1-800-772-1213. If you get benefits from the Railroad

Retirement Board, call your local RRB office or 1-800-808-0772, or

visit www.rrb.gov on the web.
6 Medicare Prescription Drug Coverage

Know how plans can market to you

Medicare now offers prescription drug coverage to all people with

Medicare. To get this coverage, you must choose a plan and join.

Here is information to help you protect yourself when dealing with

plans and others about Medicare prescription drug coverage. 

Only prescription drug plans approved by Medicare may use this seal

in their materials:

Medicare Prescription Drug Plans and people who are working

with Medicare aren’t allowed to 

• ask for your Social Security Number, bank account, or credit card

information over the telephone. 

• come to your home uninvited to sell or endorse any

Medicare-related product, but they can call you about their plan.

• enroll you into a drug plan over the telephone unless you call

them, or unless you are adding prescription drug coverage to a

Medicare plan you already have. 

• ask you for payment over the telephone or web. The plan must

send you a bill. 

Call 1-800-MEDICARE (1-800-633-4227) if you aren’t sure about

Medicare’s rules or if you think someone working with Medicare may

be breaking these rules.

Note:

If you filled out an application for extra help paying for Medicare

prescription drug coverage and there is missing information, someone

from Social Security may contact you to ask for the missing

information. They will only ask you for the information that’s missing

from the application.
What might make you suspect fraud 7

Know what to look out for

You should be suspicious of providers 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 it.

• the more tests they provide, the cheaper they are.

Be suspicious of providers that

• don’t charge copayments without checking on your ability to pay.

• advertise “free” consultations to people with Medicare.

• 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.

• bill Medicare for services you didn’t get.

• use telephone calls* and door-to-door selling as marketing tools.

• offer non-medical transportation or housekeeping as Medicareapproved services.

• put the wrong diagnosis on the claim so Medicare will pay.

• bill home health services for patients who are not confined to their

home, or for Medicare patients who still drive a car.

• bill Medicare for medical equipment for people in a nursing home.

• ask you to contact your doctor and ask for a service or supplies that

you don’t need.

• bill Medicare for tests you received as a hospital inpatient or within

72 hours of admission or discharge.

• bill Medicare for a power wheelchair or scooter when you don’t meet

Medicare’s qualifications.

Note:

* Medicare Prescription Drug Plans may call you to tell you about their

plan, but they can’t enroll you over the phone unless you call them, or

unless you are adding prescription drug coverage to a Medicare plan you

already have.
8 Fraud prevention tips

To help protect yourself and Medicare, you should report all suspected

instances of fraud and identity theft. Remember, whenever you get a

payment notice from Medicare, review it for errors. The notice shows

what Medicare was billed for, what Medicare paid, and what (if

anything) you owe. Make sure Medicare was not billed for health care

services or medical supplies and equipment you didn’t get.

The following is a list of tips to prevent fraud:

• Don’t give your Medicare number over the telephone or to people

you don’t know, except to your doctor or other Medicare provider

• Don’t allow anyone, except appropriate medical professionals, to

review your medical records or recommend services

• Don’t ask your doctor to make false entries on certificates, bills, or

records in order to get Medicare to pay

Health care fraud and abuse should be reported, whether it’s against

Medicare or private insurers. Fraud increases everyone’s health care

costs, much the same as shoplifting increases the costs of food and

clothing. To protect you and Medicare, we must work together to

reduce costs.

With help from honest health care providers, law enforcement, and

citizens like you, Medicare is doing a better job of preventing fraud and

identity theft. Some dishonest providers have gone to jail or have left

the Medicare Program. These actions are saving money for taxpayers

and protecting Medicare for the future.
What else you should know about fraud 9

If you want to know more

The U.S. Administration on Aging has programs in 

many communities that train volunteers to detect and

report fraud.

Information on these programs can be found at

www.aoa.gov on the web. If you don’t have a computer,

your local library or senior center may be able to help you

get this information.

For more information

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

1-877-486-2048.

A customer service representative can answer your questions 24 hours a

day, 7 days a week. You can also use this number to order Medicare

publications, get detailed information about the Medicare health plans

in your area (including health plan quality and customer satisfaction

information), and listen to recorded questions and answers on topics

such as Medicare health plan choices and health plan quality information.
10 Notes
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244-1850

Official Business

Penalty for Private Use, $300

CMS Pub. No. 10111

Revised April 2006

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.