MEDICARE BENEFICIARY SELF-PROTECTION GUIDE

What Every Senior Needs to Know — and Do — to Guard Their Benefits

BOTTOM LINE: Medicare fraud is not an abstract government problem — it directly threatens your benefits, your credit, and your personal medical identity. Beneficiaries who actively monitor their accounts, guard their Medicare number, and promptly report suspicious charges are the single most effective line of defense. Most fraud victims had no idea it was happening until significant damage was done.

WHY THIS MATTERS DIRECTLY TO YOU

When fraudsters bill Medicare in your name — for services you never received, equipment you never ordered, or visits from providers you never saw — several serious consequences follow:

• Your Medicare records become corrupted with false diagnoses, procedures, and prescriptions that future physicians may act on.
• Your coverage limits for certain services (skilled nursing, home health, durable medical equipment) can be exhausted by fraudulent claims before you actually need them.
• Your personal information — Medicare Beneficiary Identifier (MBI), Social Security Number, and health history — can be sold on the dark web and used in identity theft schemes well beyond Medicare.
• Aggregate fraud raises program costs, accelerating political pressure to reduce benefits or increase premiums for all seniors.

The HHS Office of Inspector General estimates that tens of billions of dollars in fraudulent Medicare claims are filed every year, and that individual beneficiaries are the most under-utilized resource in detecting it early

STEP 1: READ YOUR MEDICARE SUMMARY NOTICE (MSN) — EVERY TIME

CMS mails a Medicare Summary Notice (MSN) every three months listing all claims billed to Medicare in your name. Most beneficiaries file these without reading them. That is a critical mistake.

Review every line item. Verify that every provider, date, and service actually matches your memory of care received.

Check for providers you have never visited. A provider name you don't recognize billing for an office visit is a red flag.

Watch for duplicate charges — the same service billed twice in the same period.

Flag equipment you never received: power wheelchairs, back braces, diabetic supplies, and CPAP machines are among the most commonly billed fraudulent items.

Note charges for services on dates you were hospitalized, traveling, or otherwise unable to have received outpatient care.

If you are enrolled in Medicare Advantage (Part C), your plan will send an Explanation of Benefits (EOB) rather than an MSN. Read it with the same level of scrutiny.

STEP 2: USE MyMedicare.gov — DON'T WAIT FOR THE MAIL

Create a free account at MyMedicare.gov (medicare.gov/account/login) to access your claims in near real time — typically within 24 hours of processing — rather than waiting for the quarterly paper MSN.

Log in monthly and scan your claims history.

Use the "Blue Button" feature to download your complete claims history as a data file — useful for sharing with your personal physician or a trusted family member who helps manage your care.

Set up email or text alerts for new claims activity if your account options permit it.

STEP 3: GUARD YOUR MEDICARE BENEFICIARY IDENTIFIER (MBI) LIKE A CREDIT CARD

In 2018, CMS replaced Social Security-based Medicare numbers with new Medicare Beneficiary Identifiers (MBIs) specifically to reduce identity theft. Your MBI is the 11-character alphanumeric number on your red, white, and blue Medicare card. It is as sensitive as your Social Security Number.

NEVER give your MBI to: Anyone who calls you unsolicited — even if they claim to be from Medicare, CMS, or a federal agency. CMS does not call beneficiaries to ask for your Medicare number. This is always a fraud attempt.

Do not carry your physical Medicare card unnecessarily. Photograph it and store the image securely, or memorize the number.

Never provide your MBI in exchange for a "free" health screening, gift card, or equipment offer.

Verify any provider requesting your MBI is the one actually rendering care to you that day.

STEP 4: KNOW THE MOST COMMON MEDICARE SCAMS TARGETING SENIORS

The following schemes are currently the most prevalent, according to the HHS OIG Fraud Prevention Hotline and the National Council on Aging (NCOA):

• Medical Equipment Fraud: You are offered a "free" brace, wheelchair, CPAP device, or diabetic supplies in exchange for your Medicare number. The company bills Medicare for high-cost equipment you may receive, not need, or never receive at all.
• Genetic Testing Scams: You are approached at a health fair, pharmacy, or by phone offering a "free" genetic cancer-screening swab. Your Medicare is billed thousands of dollars for testing that is medically unnecessary and may never be reviewed by a physician.
• Telehealth Impersonation: A caller offers a free telehealth consultation, claims to be from your doctor's office or a Medicare-affiliated service, and bills for a consultation that never occurred or is medically unjustified.
• Prescription Drug Billing Fraud: Your Medicare Part D plan is billed for medications that were never dispensed, were substituted with cheaper drugs, or were prescribed by a physician who never met you — often through pill mills or corrupt pharmacies.
• Home Health Overbilling: A home health agency inflates hours of care or bills for services during periods when you were hospitalized or did not require in-home assistance.
• COVID-19 and Vaccine Scams: Fraudsters offer fake COVID tests, vaccines, or treatments in exchange for Medicare information. Though the acute pandemic phase has passed, these schemes persist.

STEP 5: REPORT SUSPICIOUS ACTIVITY — YOUR REPORT SAVES REAL MONEY

Every beneficiary report to the HHS OIG or 1-800-MEDICARE contributes to a system that recovers billions annually. OIG estimates that enforcement generates $3-$7 for every $1 invested, and individual tips have triggered multi-million dollar investigations.

When you call to report fraud, have ready: the provider name and address, the date of the suspicious service, your Medicare number (for verification purposes only), and a description of what was billed versus what actually happened.

  KEY CONTACT RESOURCES

Organization	Phone	Website	Purpose
1-800-MEDICARE	1-800-633-4227	medicare.gov	Report fraud; general benefit questions
HHS OIG Hotline	1-800-447-8477	oig.hhs.gov/fraud/report-fraud	Report Medicare & Medicaid fraud
Senior Medicare Patrol (SMP)	1-877-808-2468	smpresource.org	Free counseling; help reviewing MSNs
MyMedicare.gov	—	medicare.gov/account/login	Real-time claims monitoring
FTC Identity Theft	1-877-438-4338	identitytheft.gov	If your Medicare ID is stolen/misused
SHIP (State Health Insurance Assistance)	Varies by state	shiphelp.org	Free local Medicare counseling
NCOA BenefitsCheckUp	—	benefitscheckup.org	Verify benefits and avoid overpayment

  YOUR PERSONAL FRAUD PREVENTION CHECKLIST

Do these actions regularly to protect your Medicare benefits:

• Monthly: Log into MyMedicare.gov and review all new claims.
• Quarterly: Read your Medicare Summary Notice or Explanation of Benefits line by line.
• Immediately: Report any charge you do not recognize by calling 1-800-MEDICARE.
• Always: Refuse to give your Medicare number to anyone who contacts you unsolicited.
• Annually: Contact your State Health Insurance Assistance Program (SHIP) for a free benefits review.

After any hospitalization: Review your Medicare records for any services billed during your stay that you did not receive.

If approached for free equipment or screenings: Ask your personal physician first — legitimate providers do not solicit through cold calls or health fairs.

Prepared as a companion to: "Trillion-Dollar Drain: How Fraud, Waste, and Abuse Are Hollowing Out America's Medicaid and Medicare Programs" | February 2026

This guide is for educational purposes. For personalized guidance, contact your SHIP counselor or a licensed Medicare advisor.