How to Protect Yourself from Medicare Fraud

On October 7, 2016, the Tampa Bay Business Journal carried the news that a federal jury had convicted a man for his role in a Medicare fraud scheme. The case? Gold Care Home Health Services Inc. owner, Pilar Garcia Lorenzo, submitted claims to Medicare for services that were never provided. This is just one of the many Medicare fraud cases coming to light within the last couple of months, so make sure you get the proper healthcare from clinics that use great Medicare Advantage Solution software.

older-couple - preventing medicare fraud

According to STOP Medicare Fraud, other recent cases involve some aspect of the following:

  • A health care provider / representative billing Medicare for supplies or services never given.
  • A company offering a senior a Medicare plan not approved by Medicare. Or misleading a person with false information to join a health care plan.
  • A person using a senior’s Medicare card to get medical care or equipment.

What can seniors do to protect themselves from unsavory situations such as the above? Here are 5 tips.

1. Don’t give out personal information.

Your Medicare number can be used by fraudsters to bill Medicare for services that were never given. Or to order goods or receive care using your number. Always double check and evaluate the health care providers you are considering. Regulations state that health care plan brokers cannot call or visit your house without your permission. They are allowed to put brochures in your mailbox, but that’s about it. Health care brokers must allow you to reach out first. So if someone calls you about a plan without you requesting this information that should be a warning sign that the broker is not playing by the rules.

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2.  Examine your paperwork.

Keep track of all medical-related appointments, hospital visits, and outpatient care. When your medical bills come in, inspect the date billed against your calendar to see if they match up. If something looks suspicious, report it immediately. Or call the provider and have them explain the activity. It could be a billing error, but it might be something less savory. If you suspect fraud, pick up the phone. Call 1-800-MEDICARE (1-800-633-4227). Seniors in South Florida were able to recover $58.6 million by calling about suspicious billing activity.

3. Do your homework.

Make sure you understand what your health plan covers before you sign up. Even if it takes multiple consultations or phone calls. Keep an eye out for providers that are pushing their agenda over your needs. Or who say a service is not usually covered but they have other means for billing Medicare. These are red flags that should warn you to steer clear.

4. Check your prescription on the way out.

Did you get the full dose of the drugs you ordered? Some cases of fraud occur at the drugstore where a portion of the drugs that should go to you are sold for profit to someone else. Check the amount to make sure it is the amount your doctor prescribed. And also check the name to make sure a brand name has not been changed to something generic. Not that there is anything wrong with generic drugs. But if you have paid for a brand drug, then that’s what you should get.

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5. Be suspicious of things that sound too good to be true.

Does the offer sound too good to be true. Sadly, that’s often the case. It’s okay to use your skepticism here in the face of anyone who offers you free goods, free services, or other seemingly great offers. If they make it a time-sensitive offer that expires within a day or two—that should serve as a warning sign that something is not right. When in doubt, call up a trusted friend and ask if they have heard of the offer you are considering. You can also try contacting your Local Senior Medicare Patrol or other senior advocacy group.

Staying safe is important. For more dos and don’ts, go to’s Tips to prevent fraud page.

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1 Comment

  • Yusni Bonlingo , August 31, 2018

    Thanks for sharing this article. Very interesting read!

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