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Know a Health Care Scammer When You Hear One

When you hear about the risk of identity theft today, most of the time it’s in the context of cybersecurity – scammers hacking into people’s email or online bank accounts, for example, to steal private information such as credit card numbers and passwords, eventually wreaking havoc on consumers’ personal finances.

While the biggest risks may have moved online, old-fashioned scamming via the phone is still alive and well. And with the annual open enrollment season for health plans underway, fraudsters are even more likely to be on the prowl this time of year.

One of their most popular targets? Sadly, it’s seniors.i Seniors are at home more often to answer telephone calls and generally have saved up a “nest egg,” both of which make them more attractive to con-artists.ii

And these fraudsters are after more than just your credit card or bank information. The Washington, D.C.-based Coalition Against Insurance Fraud says health care-related scams are by far the most common type of insurance fraud in the United States, with tens of billions of dollars a year lost to a variety of false reimbursement and billing practices.iii,iv

As a first step to protecting yourself from falling victim to a health or financial scam, it helps to know how to spot these up-to-no-good crooks. Phone scammers who prey on older adults operate under various guises. Some of the more common ones:

The “health care representative”: The caller will claim to be a representative of your health plan, such as your Medicare Advantage or Medicare supplement plan. And if you’re enrolled with a national insurance company that serves a large number of members, you could be at even greater risk. Why? Phone fraud is a numbers game. Fraudsters will call hundreds or even thousands of people, pretending to represent an insurance company. If they say they’re calling from a national company, they’re more likely to reach people actually enrolled with that company.

The “government representative”: A caller might claim to be working for the government, saying he or she is calling from Medicare, for example, and is authorized to collect fees or penalties over the phone to set right some supposed problem with the person’s Medicare account.

Robocalls: These automated calls prompt you to press any key to be connected right away to an agent who can sign you up for a new Medicare card. These calls are invariably scams. Often the callers are “phishing” not just for bank or credit card information, but also Social Security numbers and health plan ID numbers they can use to carry out other types of fraud.

Medical discount plans masquerading as health insurance: Sometimes the caller will offer medical discount plans that are said to be the equivalent of insurance. In reality, most are memberships in a “club” that claims to offer reduced prices from certain doctors and pharmacies as well as on some procedures.

The “health insurance counselor”: This fraudster will offer help navigating the health insurance marketplace for a fee, capitalizing on people’s confusion about the state-based health exchanges created through the Affordable Care Act.v This sort of assistance is indeed available and is legitimate, but the people who offer it – also known as “navigators” – aren’t allowed to charge for their services. Remember that people with Medicare coverage don’t need to use the state health exchanges. The exchanges are for people under the age of 65 who are looking to enroll in an individual health plan.

In addition to knowing some of the tell-tale signs that the person on the other end of the line is a fraudster, you can protect yourself from health care phone scams in other ways as well:

  • Protect your personal information – including details about your Medicare coverage. Guard your Medicare card number just like you would your credit card number, providing it only to health care providers at the time you are seeking services.vi
  • Don’t answer a caller too quickly. It’s ok to respond to a caller’s question with questions of your own so you can better understand the purpose of the call. If someone asks for your Social Security or Medicare number, for example, you should ask why they need it, how it will be used and what will happen if you refuse to provide it.vii And remember that your health care plan already has this information, so they have no need to call you to ask for it.
  • Any form of recorded sales call is illegal without your prior written permission to receive calls from the company.viii If you receive one of these calls that prompts you to press “1” to speak to the operator or to have your name taken off a list, it’s likely a scam.ix Simply hang up.
  • One of the leading Medicare health scams involves fraudsters filing false claims for durable medical equipment such as wheelchairs, scooters, walkers and nebulizers. It’s illegal for a medical supplier to make an unsolicited phone call to people with Medicare.x So if you receive a call to buy medical equipment that your doctor hasn’t ordered, hang up.xi
  • Another health scam that’s becoming increasingly common is designed to take advantage of people who accidentally mis-dial a toll-free number (a number starting with 1-800, 1-866 or 1-877). In these scenarios, scammers purchase a toll-free number that is just one digit off from a legitimate number. When people mistakenly dial that number, they think they’re speaking with a call center agent from the company they were attempting to reach. Instead they’re on the line with a scammer. For this reason, you should be vigilant about slowly and carefully dialing toll-free numbers.
  • Carefully monitor your statements from Medicare or your health plan for any claims for services or supplies that you did not receive.
  • Trust your gut. If something sounds too good to be true – such as free medical services or equipment in exchange for your Medicare ID number – it probably is. And if any part of a phone conversation makes you uneasy, ask the caller for his or her first name and a call-back number where he or she can be reached. Better yet: Hang up and call the company or organization the person claims to be representing, using either the phone number on your health plan ID card, if the person claimed to be calling from your health insurance company, or the toll-free number on the organization’s website.
  • Report suspicious activity to local police, the state attorney general, the Centers for Medicare and Medicaid Services or the Federal Trade Commission. Doing so can help protect others from falling prey to the fraudster’s schemes.

And one final thing to keep in mind: The Centers for Medicare & Medicaid Services will be sending new Medicare cards to everyone enrolled in Medicare, starting in April 2018. The new cards will have a new number called a Medicare Beneficiary Identifier. This number will replace your current Medicare ID number, which is based on your Social Security number. Medicare is making this change to help protect people from the exact type of health care fraud described above. So don’t be alarmed if you start to receive information from Medicare in the mail about this new card. You can learn more here.


Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.