Medicare scams: Officials warn of billions in improper payments and urge vigilance

Federal authorities on Tuesday issued a warning about Medicare scams, noting that improper payments reached $54 billion in 2024. The figure underscores the scale of fraud that can affect a program funded by taxpayers and creates risk for beneficiaries who may be pressured into paying fake fees or surrendering personal information. The warning outlines how scammers operate, from fake companies filing bogus claims to direct efforts to collect Medicare numbers and other data that can be used to bill for services or equipment never requested.

Fraudsters use a mix of tactics, including setting up fake companies to file bogus claims and directly targeting beneficiaries with phone calls, emails and websites that appear to be from Medicare. Scammers seek to generate fear or a sense of urgency, pressuring people to act quickly and to provide information or make payments for services or equipment they did not request. Some schemes promise discounted prescription drugs, cheap medical devices or “upgrades” to coverage that Medicare does not offer. These schemes increasingly rely on familiar delivery channels, from spoofed phone numbers and emails to phony online portals, to create the impression that the request is legitimate. The Financial and Health Information security landscape remains dynamic, and officials emphasise that the best defense is awareness and verification before acting.

Officials emphasize that Medicare will never call to demand money or to upgrade plans, and any financial charges related to Medicare are typically mailed notices rather than phone requests. A common pattern is callers asking for a Medicare number or other personal data under the pretense of updating a plan, enabling scammers to bill for services or to impersonate the beneficiary to obtain equipment or medications. The warning also highlights the risk that stolen identifiers can be used to obtain care or prescription drugs in someone else’s name, creating gaps in coverage and potential health risks for the victim.

Beneficiaries can face more than financial loss: compromised data can lead to unauthorized services, delayed treatment, and a churn of unexpected bills that disrupt care. The advisory stresses that even a single compromised detail can be enough for a fraudster to open accounts or order equipment in a person’s name, potentially affecting the beneficiary’s health coverage and treatment options. Keeping track of care and costs becomes more challenging when identity theft intertwines with medical needs, so prevention and rapid reporting are critical.

To reduce risk, officials advise immediate action if a scam is suspected: hang up, do not engage, and report the incident to Medicare at 1-800-MEDICARE (1-800-633-4227), the U.S. Department of Health and Human Services Office of Inspector General at oig.hhs.gov/fraud/report-fraud/, and the Federal Trade Commission at reportfraud.ftc.gov/. Reporting helps authorities track patterns and disrupt criminal networks, potentially preventing harm to others.

People can take steps beyond reporting to make themselves less attractive targets. Lower online exposure by limiting personal information on public-facing profiles and data broker sites. Opt out of data broker databases where feasible, or consider a data removal service that actively monitors and clears personal details from many sites and databases. While no service can guarantee complete invisibility, reducing visibility makes it harder for scammers to tailor attacks. Limiting data exposure also helps reduce the chances that a breach or public listing can be cross-referenced with other data to locate targets.

Monitoring Medicare statements regularly is essential. Review Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) for charges for services, equipment or prescriptions never received, and report discrepancies promptly. Quick action can stop fraud before it affects care. Identity theft protection services can supplement vigilance by alerting if a Medicare number, Social Security number or other sensitive data appear on the dark web or are used to open new accounts. These tools can guide remediation if misuse occurs and help recover after an incident.

Experts warn that fraud schemes are growing more professional as criminals refine their methods and pursue larger payouts. Some cases involve advances in technology that enable more convincing impersonation and easier access to personal data. As the volume of improper payments remains high, authorities stress that staying informed, verifying information through official channels, and acting quickly when something seems off can shield beneficiaries from disruption to essential health services. The interplay between health care access and financial security is central to this issue, since health coverage is only as effective as its protections against fraud and identity theft.

Public guidance for patients and caregivers reiterates that Medicare communications about benefits or required actions should come through official channels and by mail when appropriate. If a call, email or text asks for payment, a Medicare number, or other sensitive information, it should be treated as a potential scam and dismissed. Beneficiaries are encouraged to verify any contact with their health plan or provider by calling numbers published on official materials or on the government or insurer websites, not those provided by the suspicious party. Providers and insurers also play a role in verification, often helping patients confirm legitimate changes or new coverage options before any charges are processed.

In light of evolving threats, advocates emphasize ongoing education for seniors and their families about recognizing warning signs: pressure to act quickly, requests for upfront payments or fees, and requests for personal identifiers over the phone or online. While Medicare itself has protections in place and will communicate important information through official channels, scams exploit the desire for quick access to care and cost savings. By maintaining skepticism toward unsolicited outreach and using verified routes to verify coverage, beneficiaries can preserve access to needed services while limiting risk to personal and health information.

As part of broader efforts to protect health security, authorities continue to encourage reporting and public awareness. Individuals should report suspected Medicare fraud to the appropriate agencies, seek guidance from trusted health care providers, and rely on official Medicare communications for any changes to coverage or billing. The combined effect of timely reporting, personal diligence, and protective measures can reduce the likelihood of disruption to health care while preserving the integrity of Medicare for those who rely on it most.

Looking ahead, officials say continued collaboration among health agencies, law enforcement, and consumer protection groups is essential to counter increasingly sophisticated fraud. The health and financial security of older adults depend on maintaining clear channels of communication, robust verification practices, and responsive reporting mechanisms that can adapt to new scam strategies. In health, as in other sectors, prevention starts with awareness and prompt action when something seems off. Beneficiaries are encouraged to share information about any suspicious contact with family members and trusted advisers, helping to safeguard not only their own care but the wider community that depends on a trustworthy Medicare program.

A note on how people can stay informed: federal and state resources regularly publish alerts that explain current scams and provide verified contact information. Keeping a list of official Medicare numbers and bookmark trusted sites can reduce friction during urgent health needs when time is critical. The overarching message remains simple: Medicare will not initiate a call to request payment, nor will it require payment to keep coverage active. If in doubt, pause, verify through official channels, and report what occurred. This approach helps ensure that health coverage continues to serve its intended purpose—protecting access to necessary medical care—without letting fraudsters erode that protection.