A knee brace you never ordered. A urinary catheter shipment billed month after month to an address you have never visited. A telehealth visit with a doctor you have never heard of. For millions of Medicare beneficiaries, evidence like this is sitting in a pile of unopened mail right now, because the first person positioned to catch Medicare fraud is not an investigator. It is the patient reading a statement.
The scale of the problem is not hypothetical. Last summer the Justice Department announced the largest health care fraud takedown in its history: 324 defendants charged in connection with more than $14.6 billion in alleged intended fraud, including a single scheme, dubbed Operation Gold Rush, that used stolen identities to pump an alleged $10.6 billion in claims for urinary catheters and other medical equipment through the system. Prosecutors and the HHS Office of Inspector General built those cases, but many schemes like them first surface the same way: a beneficiary spots a charge for care that never happened.
How much bad money moves through Medicare
Fraud is deliberately hard to measure, but the government does measure payment errors. CMS’s most recent accounting estimated $28.8 billion in improper payments in traditional Medicare in fiscal 2025, about 6.55 percent of everything the program paid, and that figure is an improvement on the prior year. One caution in fairness: improper does not mean stolen. Most improper payments are documentation and billing errors, not crimes. But the fraud that does exist hides inside that same billing stream, and it is caught line by line.
Your paper trail: the MSN and the EOB
If you have Original Medicare, you receive a Medicare Summary Notice, or MSN, mailed every three months in which you had claims. It lists every service and supply billed to Medicare in your name, what Medicare paid, and what you may owe. It is not a bill, which is exactly why so many people throw it out unread, and why fraudsters count on that. If you are in a Medicare Advantage or Part D drug plan, the equivalent document is the Explanation of Benefits your plan sends, typically monthly.
You do not have to wait for the mail. A free account at Medicare.gov shows claims much sooner, usually within days of processing, and Medicare’s guide to reporting fraud and abuse walks through what to look for. Checking monthly takes ten minutes.
What a bogus charge looks like
Read each line against your own memory and calendar, and flag anything in these categories:
Equipment you never ordered. Braces, catheters, glucose monitors, and wheelchairs are the classic vehicles; billing often repeats monthly once your number is in a scheme.
Providers you never saw. A doctor’s name you do not recognize, a clinic in a state you have never visited, or a laboratory running tests no one told you about.
Services that never happened. Telehealth visits you never had, ambulance rides you never took, or genetic and cardiac test kits that arrived after a phone call promising them free.
Dates that do not match. Real appointments billed twice, or office visits billed on days you were not there.
Hospice you never elected. The most dangerous one: being enrolled in hospice without your knowledge can block Medicare from paying for the ordinary care you actually need.
What to do when a line item is wrong
Start generous: call the provider’s billing office first, because a wrong code or a duplicate claim is far more common than a crime, and an honest office will correct it. If the provider cannot explain the charge, or you have never dealt with them at all, escalate. Call 1-800-MEDICARE (1-800-633-4227) with the notice in front of you, or report directly to the inspector general’s fraud hotline at 1-800-HHS-TIPS or online at oig.hhs.gov. Medicare Advantage and Part D issues can also go to the plan and to the Investigations Medicare Drug Integrity Contractor at 1-877-7SAFERX.
Every state also runs a Senior Medicare Patrol, a federally funded program whose entire job is helping beneficiaries read statements, untangle suspicious charges, and file reports. The help is free, and for anyone who finds these documents confusing, it is the single best phone call on this list.
Guard the number itself
Almost every scheme above starts with one asset: your Medicare number. Treat it like a credit card. Do not give it to anyone who calls, texts, or knocks offering free equipment, free genetic testing, or a new card. Medicare does not make unsolicited calls asking for your number, and legitimate providers do not need it as the price of a giveaway. If you have already shared it somewhere you now doubt, start watching your statements closely and tell the SMP program what happened.
The people who ran up $14.6 billion in alleged fraudulent claims were counting on statements going straight into recycling bins. Ten minutes with each notice is how you take yourself off their books.
This article was produced with AI assistance and reviewed by a human editor. Figures are linked to their primary sources; where a claim could not be verified from the public record, we say so.
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