How to Spot Medicare Scam Calls (and What to Teach Your Elderly Parents!)

According to estimates from the National Health Care Anti-Fraud Association, American taxpayers lose more than $100 billion to Medicare and Medicaid-based fraud every year – and that’s considered a conservative figure, if you can believe it. Scams thrive (to put it lightly) in this sector for a cross-section of reasons. Not only is the inspector general’s office tasked with fighting this sort of fraud woefully understaffed, with just around 450 agents to serve the entire U.S., but the grifts tend to target underserved or underprivileged groups like poor, black, and elderly Americans— the latter of whom are Medicare’s core beneficiaries.  

Up to 22% of seniors who make less than $25,000 per year report receiving fraudulent Medicare calls, an experience that can make the already confusing web of navigating America’s famously complicated healthcare systems downright nightmarish. Knowing what to look for and how to stay safe not only helps protect you, but sharing that knowledge with your elderly loved ones could save them a ton of heartbreak, and a ton of money, too.

Medicare Scam Calls

When the topic of Medicare scams pops up, most people start with one reasonable question: Does Medicare call you at home? Straight from the horse’s mouth at Medicare.gov, “Medicare will never call you to sell you anything.” In fact, “Medicare will only call and ask for personal information in limited situations,” such as when you’re already a member of a health or drug plan and more info is needed, if you’ve called Medicare and asked for a callback, or if you’ve filed a fraud report. 

Where things get sticky – and scammy – for seniors, though, is on the Medicare marketing end. Most Medicare scams occur when choosing a health care plan. While Medicare marketing isn’t illegal in America, the type of marketing is regulated (more on that later). However, because of the inherent confusion that comes with choosing Medicare plans, the majority of Medicare scam calls are marketing-related.    

Types of Medicare Scam Calls

The unfortunate reality is that the various types of Medicare scam calls cooked up by con artists are just about as numerous as the types of plans themselves. Navigating healthcare is confusing enough on its own, so keep your elderly loved ones stress-free by identifying some of the most common types of Medicare scam calls:

• Medicare card replacements. In this popular shakedown, scammers claim to be from Medicare, Medicaid, or a similar organization and call up victims, telling them that they need a new or replacement card. Of course, to get you that “new card,” you’ll need to provide the criminals with plenty of private information, which they can use to commit identity theft and eventually get to their most common target – your bank account.
• Medical equipment schemes. This one’s a little more crafty than your typical phishing attempt. Callers claiming to be Medicare reps or medical supply companies convince victims that they need medical equipment for care, with some common examples including catheters as well as knee, back, and orthotic braces. What they’re really looking for is a Medicare number, which they’ll use to order the equipment and either get a kickback on the purchase themselves or submit phony Medicare reimbursement claims for it.   
• Private Medicare sales fraud. Commonly used under the popular Medicare Advantage branding, these scammers claim to be cold-calling (a red flag) to sell plans, often offering incentives that are illegal to tie to Medicare plans, like gift cards and free meals. Sometimes, this is a phishing attempt to get that aforementioned sensitive info; other times, they’ll charge a bogus “enrollment” fee on the phone right then and there, which means the victim is not just out of money, the scammers might have their credit card info, too.
• Medicare cancellation and refunds. These calls are also phishing attempts, which means they’re out to get sensitive information like bank account info, Medicare numbers, Social Security numbers, and the like, but they commonly leverage two types of tactics. In one scenario, callers threaten to cancel Medicare coverage unless the victim can “verify” said private info over the phone. In another, they’ll claim that victims are eligible for a refund – but you’ll need to give them your Medicare number or bank account details to get the money. Spoilers: they’ll get your money instead.  

Other Types of Medicare Scams

While Medicaid and Medicare scam calls are the most common variety, today’s bad actors aren’t limited to the phone. Keep an eye out for these types of medicare scams, too, and tell your loved ones about them:

• Door-to-door Medicare. In-person “marketing reps” sometimes target seniors with tempting healthcare plans, or request additional private information for those with existing plans. Does Medicare call you at home? Only in select circumstances. But does Medicare visit your home? Absolutely not. 
• Online Medicare phishing. You’ve surely noticed that a great deal of Medicare scams are phishing hustles, and phishing doesn’t just happen on the phone – it happens online and via text, too. A lot. These forms of Medicare phishing often come with a suspicious link directing email and text recipients to a fake Medicare plan page. At the link, the victim might be prompted to enter private information (for instance, to “verify” their plan, change to too-good-to-be-true coverage, or get a “replacement card”), or the link might directly download malware onto their device. 
• Medicare malpractice by mail. Sometimes, targeted seniors will receive unsolicited genetic testing kits or a request to send in their old or expired Medicare cards by mail. While they may be wildly different things to receive in your mailbox, they’re both scams aiming for the same thing – the victim mailing in their private data in return. 

Red Crosses and Red Flags 

Medicare enrollment for senior citizens happens from October to December each year, so Medicare scams naturally spike during these periods – you’ll want to make sure the older folks in your family are especially vigilant during enrollment season. On the subject of those Medicare marketing regulations we mentioned earlier, it’s illegal for Medicare marketers to offer time-limited discounts on any plans, a common pressure tactic used by fraudsters. So that’s red flag number one. Offering gifts for enrollment is similarly illegal, and similarly scammy.

These and adjacent sorts of pressure tactics are a big warning sign. But even bigger and more obvious? It’s straight-up illegal for Medicare marketers to call beneficiaries unless the call has been requested, making unsolicited calls the deepest, most crimson flag of them all. 

Stay Safe from Medicare Scams

With 88 percent of black adults and 76 percent of white adults receiving unsolicited scam calls in the past 12 months, staying safe is more important than ever. Here are some basic rules of thumb that can help adults, elders, and everyone else stay safe from Medicare scams:

• Generally speaking, don’t disclose private information over the phone unless you are absolutely certain you’re speaking to a trusted organization. And don’t click on sketchy links, either. 
• Keep your Medicare records and benefit statements accessible and orderly so that you know for certain when scammers try to charge you for things like supplies, medications, or services you didn’t receive, or charge you double for things you did.
• Never accept gifts offered by Medicare marketers. That goes for medical gifts, too. Consider the commonly used bait phrase “paid for by Medicare” as a reason to be suspicious. Even if you get a free (often worthless) tchotchke out of it, scammers have your information, which is far more valuable. 
• Avoid joining any Medicare health or drug plans over the phone.
• If you receive medical equipment that wasn’t ordered by you or your doctor, don’t accept or open it. Instead, refuse delivery or opt to return to the sender, and keep the sender’s info on file so you can report potential fraud. Which brings us to…

Been Scammed? Take Action (and Help Others)

If you’re sure you or your loved ones have fallen victim to a Medicare phone scam, you’re not alone. First, contact your bank to come up with a solution such as putting a stop on the associated bank accounts, refunding fraudulent transactions, and blocking them from occurring again. Second, contact Medicare to report the fraud, which can help clear up your case and provide (the real) Medicare with important data for future scam prevention. You can contact them at 1-800-MEDICARE, or click the big “Report Identity Theft” button at this Medicare.gov link. 

And if you’re getting calls from suspicious numbers, you can take some preventive action of your own, too. Use Spokeo’s Reverse Phone Lookup to search millions of landline and cell records, quickly and confidentially uncovering the caller’s name and location. You’ll know if the call is legit in seconds. 

Like a good Medicare plan, staying safe from Medicare scams is good for your health, too.

As a freelance writer, small business owner, and consultant with more than a decade of experience, Dan has been fortunate enough to collaborate with leading brands including Microsoft, Fortune, Verizon, Discover, Office Depot, The Motley Fool, and more. He currently resides in Dallas, TX.