Medicare Fraud

The following statistics were obtained through Google and summarized by AI.

Did you know Medicare fraud, waste, and abuse costs taxpayers an estimated $60 billion to $100+ billion annually? The ⁠Senior Medicare Patrol notes it accounts for roughly 3% to 10% of total Medicare spending.

Federal programs and the Centers for Medicare & Medicaid Services actively track improper payments, which include fraud alongside administrative errors and missing documentation:

• Medicare Fee-for-Service (FFS): Improper payments account for roughly 6.55% of payments, totaling $28.83 billion.
• Medicare Advantage (Part C): Improper payments sit at 6.09%, or $23.67 billion, largely driven by unsupported beneficiary diagnosis data.
• Medicare Part D: Improper payments are measured at 4.00%, totaling $4.23 billion.

The U.S. government aggressively targets this issue through coordinated enforcement actions:

• DOJ Takedowns: A massive national healthcare fraud takedown by the ⁠Federal Bureau of Investigation and the Department of Justice charged 455 individuals across 45 states in connection with over $6.5 billion in alleged fraudulent schemes.
• Strike Force Results: The ⁠Medicare Fraud Strike Force cumulatively reports 3,937 indictments and 3,315 criminal actions, with billions in investigative receivables.
• Preventive Savings: CMS reports that data analytics successfully prevented $11.9 billion in potentially fraudulent payments between fiscal years 2022 and 2024.

Medical identity theft is the most common type of Medicare fraud, occurring when scammers steal your Medicare ID number to submit fake claims for health care, supplies, or prescription drugs. Knowing the specific tactics scammers use is the most effective way to protect your benefits.

So, why am I telling you this? Because I was a victim of Medicare fraud. Fortunately, it didn’t cost Medicare or me anything. I’m guessing the data analytics mentioned above caught it before anything could happen.

What happened to me?

I am very diligent in reviewing my finances. As I was checking my latest Medicare Summary Notice (MSN), I noticed something strange. Note: If you elect paperless, you can view this monthly. Paper statements are mailed quarterly. And even this is changing, because soon these will only be mailed out every six months. Paperless is the way to go, especially if you want to catch a problem earlier.

My statement for March showed a DME (durable medical equipment) claim type, but it normally shows Part B. This caught my eye. When I looked at the MSN, it showed thousands of dollars submitted for urinary catheters. Hmmm. I don’t believe I need those quite yet.

The charges were from July – December of 2025 from Flexcare Medical Solutions in Hollywood, Florida. I saw that none of the charges had been approved, but I was still concerned about why they were showing up. Before I did anything, I decided to look up this company.

Flexcare Medical Solutions is part of a widespread fraud scheme. Thousands of Medicare beneficiaries across the country are receiving Medicare Summary Notices or bills for thousands of dollars. The claims falsely state that patients ordered or received massive quantities of urinary catheters and other expensive medical supplies. Patients frequently report they live out of state, have never visited Florida, and do not use—nor have ever ordered—catheters. Furthermore, fraudulent claims sometimes list active or retired local doctors as the “ordering physician” without their consent or knowledge.

I knew right away this was a problem. I called to report it on May 5. By the way, if you ever need to call, they are open 24 hours/7 days a week. It was so tough getting through during the day that I called one night at midnight and got right through. The person I talked to took all my information and said I could be called by an investigator for more information. If there have been two or more instances, I may need to get a new card. She said to call if I saw any more claims.

I didn’t see any more claims, but in early June, I received a letter from the Center for Medicare and Medicaid Services, telling me they had found an issue with my Medicare number and were issuing me a new card/number. The letter said I should begin using my new number on June 17. I’ve already used it twice.

What should you do?

To protect yourself from Medicare fraud and abuse, keep the following in mind: 

• Record: Keep a personal log of your doctor visits, medical tests, dates, and services received.
• Review: Carefully check your Medicare Summary Notices (MSNs) or Explanation of Benefits (EOBs) against your personal records to ensure all billed items are accurate.
• Report: Notify authorities of any suspicious billing irregularities or suspected fraud.
• Remember: Never let anyone else use your Medicare card, and treat your Medicare number like a credit card to protect your identity.

I was lucky this time. Who knows how my Medicare number was obtained. And if it happened to me, it can happen to anyone. Please be diligent and never assume everything is correct. There are too many criminals out there.