This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Medicare and Insurance Fraud — How Scammers Target Seniors

Your parent gets a call from someone claiming to be from Medicare. Your parent's Medicare number has been flagged due to suspicious activity. Your parent needs to verify their information right now or their coverage will be suspended. The caller sounds official. They use the right terminology. They might even have some real information about your parent, like an address or part of a Social Security number.

Your parent is worried. Medicare is essential. If coverage gets suspended, medical bills will be astronomical. Your parent complies. They give their Social Security number, their Medicare number, their banking information, whatever the caller asks for. By the time your parent realizes the call was from a scammer, sensitive information is out there and there's potential for identity theft or financial fraud.

Medicare fraud targeting elderly people is massive and growing. Scammers know that elderly people rely on Medicare, they trust official-sounding calls, and they're often willing to provide information quickly when they think their health coverage is at risk. Understanding how these scams work and what your parent should do protects your parent's healthcare access and their financial security.

Understanding the Basics

Medicare fraud targeting seniors usually starts with a call, though it can also be an email or a text. The scammer claims to be from Medicare, from Medicare Advantage plans, from Medicare Part D prescription coverage, from the Centers for Medicare and Medicaid Services, or sometimes from specific insurance companies. The official-sounding names and terminology make the call seem legitimate.

The reason for the call varies. Sometimes the scammer says your parent's Medicare number has been compromised. Sometimes they say Medicare needs to update information. Sometimes they say Medicare found fraudulent charges on the account. Sometimes they say your parent's benefits are being suspended. The urgency is always there. Act now or something bad happens.

The information they're after also varies. Sometimes it's the Medicare number. Sometimes it's the Social Security number. Sometimes it's banking information. Sometimes it's the address and phone number. Each piece of information has value for identity theft or direct financial fraud.

Here's what's important: Medicare will never call you to ask for this information. Medicare will never call you to suspend or update coverage. Medicare communicates officially through the mail. If your parent gets a call from someone claiming to be from Medicare asking for personal information, it's a scam. That's the rule with no exceptions.

Insurance fraud beyond Medicare works similarly. Scammers call claiming to be from health insurance companies, auto insurance, or home insurance. They claim there's a problem that needs fixing or that your parent qualifies for a refund. They ask for personal information or banking details. They're scamming people who are paying for insurance and might not realize they're being targeted.

Your Parent's Specific Situation

How much does your parent understand about their Medicare coverage? Does your parent know what Medicare covers, when coverage takes effect, what their responsibilities are? If your parent doesn't fully understand Medicare, they're more vulnerable to being confused by an official-sounding call claiming there's a problem.

What other insurance does your parent have? A Medigap policy, a Medicare Advantage plan, prescription drug coverage, supplemental insurance? The more coverage options, the more potential confusion, and the more vulnerable your parent becomes to someone claiming there's a problem with one of the policies.

Has your parent been targeted by scams before? If your parent has been vulnerable to other scams, they might be vulnerable to this one too. Scammers share information about people who fall for scams, because they're more likely to fall for the next one.

How does your parent typically respond to calls from unfamiliar people? Does your parent immediately trust the caller if they sound official? Does your parent ask questions? Does your parent hang up if something feels wrong? Your parent's natural tendency to trust or verify tells you whether they need additional protection.

Does your parent have a trusted person they can call to verify situations like this? You, another family member, a friend? If your parent knows they can quickly call someone to say "I got a weird call from Medicare, is this real?" then verification becomes easier.

Taking Next Steps

Educate your parent about how Medicare actually communicates. Medicare communicates through official mail, not unsolicited calls. If your parent has a question about Medicare, your parent should call Medicare directly using a number they know is correct, not call the number the suspicious caller provided. Medicare's actual number is on their materials, their card, or their website.

Help your parent understand that even if the caller uses real information, that doesn't mean the call is legitimate. Scammers can know someone's address or part of their Social Security number. Real information doesn't equal a real call.

Set up a system where if your parent gets a suspicious call, they can contact you to verify. "I got a call from Medicare saying my number is compromised. Is that real?" You can help your parent check official sources and confirm whether the call is legitimate.

Suggest that your parent not answer unsolicited calls from unfamiliar people. Calls from doctors' offices, pharmacies, or people your parent actually knows are different. A call from someone claiming to be from Medicare but who your parent doesn't know is suspicious. Your parent can let it go to voicemail and return calls to numbers they know are correct.

Encourage your parent to report suspicious calls to Medicare and to law enforcement. The Federal Trade Commission tracks these scams and uses the information to prosecute scammers. Your local police might also have a fraud unit that investigates these crimes.

Install call-screening technology on your parent's phone if possible. Apps like Nomorobo or services offered by your parent's phone company can block or flag suspected scam calls. These aren't perfect, but they reduce the number of suspicious calls your parent has to deal with.

If your parent falls for the scam and provides information, the first step is contacting their bank and credit card companies to alert them to potential fraud. The second step is placing a fraud alert with the three credit bureaus (Equifax, Experian, TransUnion). The third step is monitoring their credit report for suspicious activity. If your parent's Social Security number was compromised, theft and identity fraud become possible.

Help your parent monitor their actual Medicare statements. Medicare sends statements showing what claims were processed. Your parent should review these and report anything they don't recognize. If a scammer is billing Medicare fraudulently under your parent's number, the statements might show the fraud.

The reality of Medicare fraud is that your parent doesn't have to take the bait. Medicare won't call. If someone calls claiming to be from Medicare, it's a scam. Your parent's job is to hang up and call a real Medicare number. That one action stops the scam before it happens.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.