Types of Medicare Fraud Targeting Seniors: What Every Caregiver Must Know

Medicare fraud costs the U.S. government an estimated $60 billion a year — and a significant chunk of that money is stolen directly from seniors, not just from the government. When a provider bills Medicare for services your parent never received, your parent's benefits are quietly depleted. When a scammer calls pretending to be a Medicare representative, they walk away with your parent's Medicare number, Social Security number, and potentially their bank account.

For adult children managing a parent's healthcare, understanding the specific types of fraud is the difference between catching it early and discovering a $30,000 hole in your parent's benefits that took three years to drill.

Why Medicare Is Such a Rich Target for Scammers

Medicare beneficiaries are predictable, reachable, and carry extremely valuable credentials. A Medicare number, combined with a Social Security number, is all a criminal needs to bill for equipment, procedures, and medications that were never delivered. Because billing flows through a complex system with millions of claims, fraudulent charges can take months or years to surface — by which time the scammer is long gone.

Seniors are also more likely to trust calls from people claiming to represent Medicare or a health insurance company, especially if they have recent experience with confusing bills, plan changes, or hospital stays.

The 8 Most Common Types of Medicare Fraud

1. Billing for Services Never Provided

This is the most common and financially largest type of Medicare fraud. A provider — a home health agency, a physical therapy clinic, a durable medical equipment (DME) company — submits claims to Medicare for services that were never performed or equipment that was never delivered.

Your parent receives an Explanation of Benefits (EOB) showing charges for a wheelchair, a hospital visit, or a series of lab tests they have no memory of. Because Medicare EOBs can be confusing to read and seniors often receive them months after the alleged service date, these charges frequently go unchallenged.

What to watch for: Review every Medicare Summary Notice or EOB your parent receives. Look for provider names you don't recognize, services that don't match what actually happened, or dates when your parent was not seen by any doctor.

2. Upcoding and Unbundling

These are provider-side frauds that are harder for families to detect but worth knowing about:

• Upcoding: A provider bills for a more expensive service than what was actually performed. For example, billing a 60-minute complex consultation when your parent had a 15-minute routine follow-up.
• Unbundling: Procedures that are normally billed as one package are split into separate charges to inflate reimbursement. A single surgical procedure becomes five separate line items, each billed at full rate.

These frauds inflate what Medicare pays and can exhaust your parent's benefits faster than they should.

3. Medicare Impersonation Calls

This is the scam most likely to directly harm your parent through identity theft. A caller claims to be from Medicare, the "Medicare Benefits Department," or a Medicare Advantage plan administrator. They say your parent needs a new Medicare card, or that there's a problem with their coverage, or that a new benefit is available — but they need to "verify" your parent's Medicare number to process it.

The hard truth: Medicare will almost never call your parent unsolicited. If they do need to reach a beneficiary, they send a letter. Medicare will never call and ask for your parent's Medicare Beneficiary Identifier (MBI), Social Security number, or bank information over the phone.

If someone calls claiming to be Medicare and asks for any personal information, hang up. Call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to verify whether there's actually an issue.

4. Free Equipment or Testing Scams

This type of fraud often starts with a legitimate-sounding offer: "We're offering free diabetic testing supplies / back braces / knee braces to Medicare beneficiaries at no cost to you." Your parent provides their Medicare number to "verify eligibility" — and the fraudster either uses the number to bill for equipment never shipped, bills for far more expensive equipment than described, or sells the number on the dark web.

The "free" equipment is a hook. The real product is your parent's Medicare credentials.

What to watch for: Any unsolicited contact offering free medical equipment, testing, or supplies in exchange for a Medicare number is a scam. Legitimate DME suppliers require a doctor's prescription and a referral — they do not cold-call seniors with offers.

5. Prescription Drug and Pharmacy Fraud

This category includes several related schemes:

• Billing for brand-name drugs when generics were dispensed (or billing for drugs not dispensed at all)
• Prescription drug plan scams where a caller claims your parent's Part D plan is changing and they need to "re-enroll" immediately, collecting personal information in the process
• Pill mills — clinics that prescribe unnecessary medications or controlled substances and bill Medicare for the visits

Prescription fraud can also put your parent's health at risk if medications are being swapped, diluted, or simply not provided.

6. Fake Medicare Advantage Plan Switching

During and around Medicare's Annual Enrollment Period (October 15 – December 7), scammers posing as insurance agents or Medicare representatives contact seniors with urgent pressure to switch Medicare Advantage plans. The agent may misrepresent plan coverage, enroll your parent in a plan without their true informed consent, or simply collect personal information and disappear.

Aggressive door-to-door "agents" appearing at senior centers or calling repeatedly to push plan switches are a major red flag. Legitimate Medicare Advantage plan representatives are not allowed to conduct unsolicited door-to-door sales visits.

7. Ambulance Billing Fraud

Some ambulance companies bill Medicare for emergency transport that was not medically necessary, or for transport that never occurred. Your parent may receive an EOB showing an ambulance claim for a date when they drove themselves to an appointment.

This is particularly insidious because ambulance bills are large (often $1,000–$3,000 per transport) and your parent may not notice a bill they assumed Medicare handled automatically.

8. Home Health Billing Fraud

Home health agencies are a significant source of Medicare fraud. Common schemes include:

• Billing for visits by a home health aide when no visit occurred
• Inflating the number of visits (billing for five when there were two)
• Claiming the patient is "homebound" when they are not, in order to qualify for home health benefits
• Billing for skilled nursing care when only companion/personal care was provided

If your parent uses a home health agency, keep a simple log of who visited and when. Compare it against the Medicare Summary Notice.

How to Report Medicare Fraud

Medicare fraud is a federal crime. Reporting it not only protects your parent — it can protect thousands of other seniors targeted by the same operation.

• Call 1-800-MEDICARE (1-800-633-4227) to report directly to Medicare
• Submit a report to the HHS Office of Inspector General: oig.hhs.gov (online hotline) or 1-800-HHS-TIPS
• Contact the Senior Medicare Patrol (SMP) in your state — a federally funded program staffed by volunteers who help seniors detect, prevent, and report fraud. Find your local SMP at smpresource.org
• File with the FTC at reportfraud.ftc.gov if you believe personal information was stolen

If your parent provided their Medicare number to a suspected scammer, report it to Medicare immediately and request a replacement Medicare card with a new number. This can be done at MyMedicare.gov or by calling 1-800-MEDICARE.

Practical Steps to Protect Your Parent Now

Review EOBs together every month. Medicare Summary Notices arrive quarterly in the mail; the MyMedicare.gov portal shows claims in real time. Make it a habit to go through them with your parent and flag anything unfamiliar.

Set up a Medicare.gov account for your parent. With their permission, you can monitor their claims, check their Part D drug plan, and see their coverage summary without needing to call Medicare each time.

Establish the rule: never give out the Medicare number over the phone. Treat the Medicare Beneficiary Identifier (MBI) the same as a Social Security number. No legitimate provider will cold-call and ask for it.

Opt out of the Medicare member directory. Your parent can ask Medicare not to share their information with third-party contractors for marketing purposes.

Check provider directories against actual care. If your parent receives an EOB from a provider they have never visited, call that provider and ask for an itemized bill. Then call Medicare and report the discrepancy.

Medicare fraud is not a passive threat. The schemes described above are organized, professionalized, and run at industrial scale. The good news is that most of them leave a paper trail — and that trail is the Medicare Explanation of Benefits sitting in your parent's mailbox right now.

If you want a complete system for protecting your aging parents — covering phone scams, identity theft, financial exploitation, and the digital footprint they leave behind — the Elder Scam Shield guide gives you the step-by-step tools to build that protection. From setting up fraud monitoring to the exact scripts for talking to a parent who's already being targeted, it covers the ground that Medicare's fraud hotline doesn't.