Medicare Fraud Alert: Why You Should Review Your Claims Regularly

Most Medicare beneficiaries assume that if they didn't order something, nobody can bill Medicare for it.

Unfortunately, that's not always the case.

Recently, one of my clients discovered a claim on her Medicare Advantage plan for medical supplies she never requested and never received. After investigating, we found reports linking the supplier to a nationwide billing scam involving fraudulent medical equipment claims.

This serves as an important reminder: every Medicare beneficiary should regularly review their claims and Explanation of Benefits (EOB) statements.

How Medicare Fraud Happens

Scammers often obtain Medicare numbers and personal information through phone calls, data breaches, online scams, or other fraudulent methods.

They may then:

• Submit claims for medical supplies you never received

• Bill for durable medical equipment you never ordered

• Charge Medicare for services that never occurred

• Use your Medicare information to commit identity theft

In many cases, victims don't realize anything happened until they review an Explanation of Benefits statement or receive a bill.

Watch Out for This Common Scam

Many Medicare beneficiaries are currently receiving phone calls, text messages, emails, and voicemails claiming:

"Your Medicare file has not been transferred into Medicare's national database."

Or:

"Your Medicare profile needs to be updated for 2026."

Or:

"Your Medicare coverage could be delayed if you don't verify your information."

These messages are fraudulent.

Medicare does not call beneficiaries out of the blue to request personal information, verify account details, or transfer files into a national database.

If you receive a call, text, email, or voicemail like this:

• Do not provide your Medicare number

• Do not provide banking information

• Do not click links

• Do not return the call

Delete the message and report it if appropriate.

How to Check for Medicare Fraud

I encourage all clients to periodically review:

• Medicare Summary Notices (MSN)

• Medicare Advantage Explanation of Benefits (EOB) statements

• Prescription drug claims

• Medical supply claims

Look for:

• Services you never received

• Medical equipment you never ordered

• Doctors you never visited

• Claims from unfamiliar companies

• Duplicate charges

Even small suspicious claims should be investigated.

What to Do If You Find a Fraudulent Claim

Step 1: Contact Your Insurance Company

If you're enrolled in a Medicare Advantage plan, call the member services number on the back of your ID card.

Explain that you believe a claim may be fraudulent and ask them to investigate.

Step 2: Document Everything

Keep copies of:

• EOB statements

• Claim information

• Bills received

• Phone numbers involved

• Names of representatives you speak with

Step 3: Contact Medicare

You can report suspected Medicare fraud directly to Medicare by calling:

1-800-MEDICARE (1-800-633-4227)

Step 4: Report Identity Theft Concerns

If you believe your Medicare number has been compromised, ask Medicare and your insurance carrier what additional protective steps should be taken.

Step 5: Notify Your Medicare Advisor

If you're a client of The Medicare Butler, let me know as well.

While I can't process fraud investigations, I can often help you understand what you're seeing on your statements and point you in the right direction.

The Best Defense Is Awareness

Most Medicare fraud schemes succeed because beneficiaries don't know they're being targeted.

By reviewing your claims, protecting your Medicare number, and remaining skeptical of unsolicited phone calls, texts, and emails, you can dramatically reduce your risk.

If you ever have questions about a suspicious Medicare claim or communication, don't hesitate to reach out.

Sometimes a quick phone call can prevent a costly mistake.

— Rodney Butler
The Medicare Butler