Common Warning Signs of Medicare Fraud Beneficiaries Should Know

Medicare scams are unfortunately on the rise, targeting both older adults and the healthcare system. By learning the warning signs, pharmacists can help protect patients from financial loss, identity theft, and unnecessary harm.

Here, we highlight common techniques scammers use to target beneficiaries. Educating your patients about these signs can help them stay vigilant against potential scams.

1. Unsolicited Calls or Offers

   Scammers may call patients out of the blue offering “free” medical equipment, genetic tests, or prescription discounts in exchange for a Medicare number. Legitimate providers do not cold-call to sell services covered by Medicare.

2. Pressure to Share Medicare Information

   Scammers often use scare tactics such as threatening loss of coverage unless patients provide their Medicare number immediately. Any message that pressures patients to act immediately is a red flag.

3. Billing for Services Never Received

   Pharmacists may notice claims for medications or supplies a patient never picked up. Patients may also receive Explanation of Benefits (EOB) statements listing items they don’t recognize. Encourage your patients to review their Medicare statements regularly and report errors right away.

4. Claiming Beneficiaries are Eligible for a Refund 

   Scammers may call or email beneficiaries claiming they are due a Medicare refund and ask for personal information or bank account details to process it.

5. Suspicious Prescriptions from Unknown Providers

   If prescriptions appear under a patient’s profile from providers they don’t know, fraud may be involved.

   
   

   Remind patients they can report suspected fraud to 1-800-MEDICARE (1-800-633-4227), local law enforcement, or the Office of Inspector General at 1-800-HHS-TIPS (800-447-8477).