What Can a Scammer Do With Your Medicare Number?

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Jory MacKay

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    How Safe Is Your Medicare Number?

    According to the FBI’s Internet Crime Complaint Center (IC3), healthcare-related fraud saw a 110% increase in victims from 2019 to 2020 [*]. The reported losses demonstrated an even more significant increase, rising from $1.1 million to $29 million in the same time period.

    Unfortunately, all scammers need to steal your health benefits is your Medicare number. 

    The most common scam involves fraudsters claiming to be Medicare agents. They’ll use publicly available personal information — like your full name and date of birth — to gain your trust before asking you to “confirm” your Medicare number. 

    Medicare Open Enrollment (MOE) days, in particular, attract all kinds of scammers who may actively try to steal your number.

    So, how safe is your Medicare number? What can you do to protect yourself from these fraud schemes? In this guide, we’ll explain how scammers steal your Medicare information, what they can do with it, and how to keep yourself safe.

    What Can Someone Do With Your Medicare Number?

    In the wrong hands, your Medicare number may be used for a variety of scams including filing for false claims and reimbursements. Just recently, a cardiologist from Long Island billed Medicare and Medicaid $1.3 million [*] for unneeded tests on patients. 

    To learn more ways to help prevent Medicare fraud visit: www.medicare.gov/fraud.

    Like with your credit card, scammers can do considerable damage with stolen Medicare numbers. When bad actors misuse stolen doctor and patient identities, it costs taxpayers billions.

    For example, medical identity theft can cost you copayment, and cap out your benefits faster. Those unpaid bills can quickly become medical debts that undermine your credit report.

    Even worse, any treatment obtained by the scammer becomes part of your medical records. This can be fatal in emergencies as doctors may use the fraudulent medical history to determine their next line of treatment. 

    Pro tip: Avoid carrying your Medicare card unless you're going to the hospital or pharmacy. Set up a secure online Medicare account instead to view your claims via the Social Security Administration (www.ssa.gov/myaccount/).

    How To Spot Medicare Fraud Before It Happens to You

    It's not always easy to recognize a medical scammer or identity thief — especially if you don’t know how to tell if someone is scamming you

    Luckily, there are some clear warning signs that can help identify Medicare scammers. 

    A Medicare scammer typically:
    • Calls you even though you’re not enrolled in any Medicare health plan.
    • Will ask for details such as your Social Security, Medicare, or bank account numbers to give you a quote for a plan.
    • Pushes for a payment online or over the phone without sending you a bill.
    • Pitches a different product, such as a life insurance policy, instead of sticking to Medicare plans.
    • Engages you in conversation about Medicare plans in a healthcare setting, like in an examination room or at a pharmacy counter.
    • Charges you a fee to turn your enrollment into a plan.
    • Pressures you to sign the enrollment form before you’re ready.
    • Requests that you share the names, phone numbers, and addresses of your family members and friends so they can pitch their scams to them.
    • Visits you without your invitation to sell you a plan.
    • Attempts to influence what plan you choose with erroneous information.
    Other telltale signs you shouldn’t ignore:
    • Pressuring you to enroll in limited-time offers outside of the MOE period.
    • Offering early-bird discounts and offers.
    • Providing gifts or services above $15 in return for choosing their plan.
    • Free health screenings (also known as cherry-picking).
    • Enrolling you in incorrect Medicare plans.
    • Insisting you switch from your current plan to one they propose.
    • Trying to issue you a “new” Medicare card to keep your coverage active.

    Pro tip: Check to see if your sensitive information has been leaked to hackers on the Dark Web using Aura’s Identity Guard Dark Web Scanner.

    Aura Identity Guard Dark Web scanner

    Beneficiaries Beware: 10 Medicare Scams To Know Of

    In the unfortunate event that you fall victim to health care fraud, here’s what scammers may do with your Medicare number:

    1. Identity theft or identity swapping
    2. Double billing
    3. Phantom billing
    4. Upcoding
    5. Unbundling
    6. Bogus marketing
    7. Impersonating a healthcare professional
    8. Prescription forgery
    9. Drug diversion
    10. Doctor shopping

    1. Identity theft or identity swapping

    Identity theft (or identity swapping) is when someone uses your personal information to commit fraud. 

    But can someone steal your identity with just your Medicare card or number? Unfortunately, they can.  

    Watch now: Hear an actual medicare scam phone call shared by the FTC ->

    With medical identity theft, the scammer uses personal information like your Medicare number to access medical care. For example, they might see a doctor, get prescriptions, or file claims with your insurance provider. 

    See the scam in action:

    If a criminal uses your personal health information (PHI) for identity theft, you could end up with: 

    • Bills for services and prescriptions you never received. 
    • Charges for treating conditions you do not have.
    • Calls from a debt collector inquiring about a medical debt you do not owe.
    • Notices from your health insurance company about maxed out benefits.
    • Denied insurance coverage, or an increase in your annual insurance costs because of a false pre-existing condition on your medical record.

    Pro tip: Sign up for a family identity theft monitoring plan. For example, Aura can track and alert you if your or a loved one’s SSN is at risk online. And if the worst happens, all adult members are covered by a $1,000,000 insurance policy for elligible losses due to identity theft.

    Aura Family Identity Theft Protection plan
    [Source: Aura family identity theft protection]

    Related: The Top 10 LifeLock Competitors & Alternatives For 2022

    2. Double billing

    Double or duplicate billing is when a scammer bills Medicare multiple times for a service you only received once. Unscrupulous medical providers are typically the kingpins of this scam.

    Although Medicare has a structure to deny exact or suspect duplicate claims, double billing is still at large. Protect yourself by carefully checking your itemized medical bills. Take note of the procedures your provider has billed you for. If you notice irregularities in your statements, make a report. 

    Double billing is a serious healthcare fraud allegation for which perpetrators can be fined or imprisoned.

    See the scam in action:
    1. Two healthcare providers bill you for the same service performed on the same day. 
    2. One provider bills you for the same service twice. 
    3. You’re billed for a service as a single procedure and billed again for it as part of a bundled set. 
    4. Your provider may send Medicare the bill — and send you the same bill. 

    Related: 9 Types of Financial Fraud & How To Protect Yourself

    3. Phantom billing 

    Phantom billing occurs when a scammer submits bills for services, drugs, or equipment that you never received. You may get bills for lab tests or dental fillings you never had done. This is another scam that often originates from dishonest healthcare providers. 

    See the scam in action:
    1. Unrequested medical services. An example would be getting a delivery of back braces to your home when you’ve never had a problem with your back or paid for back braces.
    2. False billing. Scammers may use false companies to bill you and then receive the funds. They may also use real medical organizations who offer kickbacks on the fraudulently obtained funds.
    3. Suspicious Medicare Summary Notices (MSN). These quarterly statements show the details of all your Medicare claims. Review these for unfamiliar doctor visits of services. 

    Did you know? Electronic Medicare Summary Notices (eMSNs) let you check your claims online almost instantly? Sign up on MyMedicare.gov.

    4. Upcoding

    Current Procedural Terminology (CPT) codes are numbers that represent the services a healthcare provider offers. For example, there are unique codes for different diagnostic, medical, and surgical services. 

    An example CPT code sheet
    A sample of CPT codes by the American Medical Association (AMA). Source: Centers for Medicare & Medicaid Services (CMS)

    Healthcare providers use these numbers to list the services provided when billing Medicare. Medicare, in turn, uses the numbers to determine how much to pay. But scammers can also use them to overcharge Medicare beneficiaries.

    See the scam in action:

    Bloated Estimate of Benefits (EOB). In an upcoding scam, a health provider assigns your procedure a wrong code. As a result, Medicare is billed for services you did not receive or, in most cases, an exaggeration of the services you did receive.

    For example, a visit from a regular patient could be coded instead as a first-time consultation, which would cost more.

    5. Unbundling

    Unbundling — also known as fragmentation — is when scammers bill Medicare separately for all steps of a procedure.

    For example, many CPT codes cover full surgeries. But if a healthcare scammer uses separate CPT codes for each step, they can get higher reimbursements.

    An example of an "unbundled" medical bill scam
    An example of an unbundled bill where a patient was charged $722.50 for a nurse to "push" drugs into her IV. Source: NPR
    See the scam in action:
    1. Fragmenting one service into separate parts while tagging each part under distinct CPT codes.
    2. Reporting multiple CPT codes for related services that fall under one comprehensive CPT.
    3. Using bilateral procedures when only one code is required.
    4. Separating charges for one major surgery.

    6. Bogus marketing

    Bogus marketing refers to scammers trying to gain access to sensitive Medicare information under the guise of marketing.

    The scammer, usually associated with a telemarketing firm, will pitch fake benefit plans over a phone call. Typically, these plans will require you to disclose personal details to enroll. 

    Once you share your information, the scammer may use it to steal your identity and bill Medicare for services you did not receive. Often, the bill will be issued by a medical provider or entity unknown to you. 

    A nationwide medical equipment scam
    The inner workings of an alleged nationwide Medicare scam. Source: U.S. Department of Health and Human Services

    This scam is especially common during the Medicare Open Enrollment (MOE) period, which runs from October 15 to December 7. 

    See the scam in action:
    1. Call centers, telemedicine or medical equipment providers reach out to seniors offering “free” services.
    2. Interested, unsuspecting beneficiaries verify their Medicare coverage before consultations with doctors.
    3. These doctors then write bogus prescriptions for medical equipment. The colluding manufacturers will bill Medicare and offer kickbacks of up to $300 in some cases.

    Medicare will not call you out of the blue to sell you a plan. So if you get a call from someone claiming to be a Medicare agent, hang up immediately — even if your caller ID identifies them as Medicare.

    Related: The Best Ways To Protect Yourself From Identity Theft → 

    7. Impersonating a healthcare professional

    In this scam, a person who is not properly licensed and certified provides you with medical services and then bills Medicare. When such a person makes a claim, it is known as a false claim; and if the payment is made, it is regarded as fraud. 

    See the scam in action:

    Medicare only pays for services provided by licensed professionals. For example, if you’re a patient in New Jersey and an unlicensed doctor authorizes a lab test for you and bills Medicare, it may be considered a false claim.

    Providers on a state or federal exclusion list may also be regarded as fraud claimants. 

    The bottom line? Always make sure your healthcare providers are licensed before receiving medical care.

    8. Prescription forgery

    Scammers may also use your Medicare number to obtain prescription drugs. Prescription medications obtained illegally are often used by the scammers themselves or sold.

    See the scam in action:

    Forged prescriptions are usually written on a valid blank prescription. Some telltale signs of forged prescriptions include spelling mistakes, overwriting, and use of photocopied forms. Still, some pharmacists may overlook these signs. 

    Statistics on health care fraud around prescriptions
    Source: U.S. Department of Justice

    Unfortunately, forged prescriptions are becoming more commonplace. There were more than 12 million occurrences in 2021 alone [*].

    If you are enrolled in a Medicare Part D Plan or Medicare Advantage Plan with drug coverage, you will receive an EOB notice. This notice contains the details of the prescription drugs you filled. Carefully review your EOB to ensure it does not contain prescription drugs you did not receive or do not use.  

    9. Drug diversion

    Prescription drug diversion is when a scammer "reroutes" drugs from a patient to another individual. Diversion of drugs is more common with prescription drugs and controlled substances. 

    See the scam in action:

    A scammer can use your Medicare number to divert your legal prescriptions and use them illegally. This might include selling the pills for profit or using your prescribed drugs themselves.

    While these scammers are usually random criminals, healthcare providers are sometimes involved.

    Drug diversion will affect the standard of care you receive, possibly even denying you essential pain medication. If you’re missing prescription medication (but are still getting billed for it), you may be the victim of a drug diversion scam. 

    10. Doctor shopping

    A scammer can use your coverage to get prescriptions from different healthcare providers. The providers are usually unaware that the individual has received the same prescription elsewhere. 

    See the scam in action:

    Some of these scammers may have real medical problems, while others sell the prescription drugs illegally. The scammers may use fraudulent documents, resources, and information found on the internet

    They may claim that they cannot visit their regular doctor because they have moved or are having trouble booking an appointment. Such fraudsters may also deny receiving a prescription, or claim that they lost the previous medication.

    Doctor shopping is considered a felony in all states and may lead to felony charges and payment of a fine. If a scammer uses your Medicare number for doctor shopping, you will be implicated in the fraud.

    Notice Anything Suspicious? Here’s How To Report Medicare Fraud

    If any of these warning signs seem familiar to you, you may be at risk of Medicare fraud. 

    Here’s what to do next if you suspect fraud.

    Call the CMS hotline:

    • 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048

    And the Office of the Inspector General (OIG) hotline: 

    • Phone: 1-800-HHS-TIPS (1-800-447-8477) or TTY 1-800-377-4950
    • Fax: 1-800-223-8164
    • Online: Forms.oig.hhs.gov/hotlineoperations/index.asp
    • Mail: U.S. Department of Health & Human Services, Office of Inspector General, ATTN: OIG Hotline Operations, P.O. Box 23489, Washington, DC 20026

    For Medicare Part C (Medicare Advantage) or Part D (Prescription Drug Plans) complaints:

    • 1-877-7SafeRx (1-877-772-3379)
    Also have this information ready beforehand:
    • Your name.
    • Medicare number.
    • The healthcare provider’s name, and other identifying details you may know.
    • List of items or services you’re skeptical about, and the supposed date you received it.
    • Payment amount that Medicare approved and paid.
    • The date on your MSN or claim.

    Stay Alert and Protect Yourself Against Medicare Fraud

    From phony vaccination cards to enticing older patients with unnecessary treatments, Coronavirus and Medicare scams show no signs of slowing down. 

    Being aware of how these scammers seek out and use your personal information is the best way to protect yourself from Medicare fraud.

    Make it a habit to check your MSNs and credit statements carefully. The earlier you notice errors, the faster you’ll be able to stop possible fraud. If you have shared your SSN and other details with a stranger and suspect you are a victim of medical identity fraud, report it to the police. Then, file a report with the FTC at www.IdentityTheft.gov.

    For added protection, sign up for Aura’s identity theft protection plan. We’ll monitor your personal information for signs of identity theft and alert you of any suspicious activity. 

    And if the worst happens, you’re covered by a $1,000,000 insurance policy for eligible losses due to identity theft.

    Ready for ironclad protection? Start your free 14-day trial of Aura today.

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    1. Financial identity theft and fraud
    2. Medical identity theft
    3. Child identity theft
    4. Elder fraud and estate identity theft
    5. “Friendly” or familial identity theft
    6. Employment identity theft
    7. Criminal identity theft
    8. Tax identity theft
    9. Unemployment and government benefits identity theft
    10. Synthetic identity theft
    11. Identity cloning
    12. Account takeovers (social media, email, etc.)
    13. Social Security number identity theft
    14. Biometric ID theft
    15. Crypto account takeovers