What are the warning signs of Medicare fraud?
Medicare.gov lists these red flags:
- Calls or visits offering to sell you something. Medicare will never call you to sell you anything or visit you at your home.
- Offers of money or gifts in exchange for medical care, or promises that a test or piece of equipment won't cost you anything if you just share your Medicare number.
- Someone other than your doctor reviewing your medical records or recommending services.
- Pressure to join a Medicare health or drug plan over the phone, unless you called and asked for help.
- Statements listing services or supplies you didn't get. Compare your Medicare Summary Notice or Explanation of Benefits with your calendar.
Your Medicare number is like a credit card number. Give it only to your doctors and other providers, your insurance companies, and people you trust to help with your Medicare. If someone calls out of the blue asking for it, hang up.
Which scams target people with Medicare in North Carolina?
"You need a new Medicare card"
A caller says your card is being replaced, or that you need a new plastic or "chip" card, and asks you to confirm your Medicare number or bank information. Medicare doesn't make calls like that. If you lost your card, print an official copy from your Medicare.gov account or call 1-800-MEDICARE yourself.
Braces, genetic tests and supplies you never ordered
The HHS Office of Inspector General (HHS-OIG) warns about callers and ads promising people with Medicare a back or knee brace, or a cheek-swab genetic test, that "won't cost you anything." If you give or confirm your Medicare number, a brace or test kit may arrive that you didn't want, and Medicare is billed. If Medicare denies a genetic test claim, you could owe the full cost. Federal law generally bars medical equipment suppliers from making unsolicited calls to people with Medicare about covered items. Refuse or return anything your own doctor didn't order, and report it.
Callers who say they're "from Medicare"
Medicare's marketing rules bar plans and agents from unsolicited calls and door-to-door sales (42 CFR 422.2264). Be extra careful this fall: Open Enrollment runs through December 7, 2026, and at least 30,654 North Carolinians must choose new coverage because their plan ends in 2027. A real licensed insurance agent will give you their name and license number; check it with the lookup NCDOI links to (see how to find a licensed agent). If someone enrolled you in a plan you didn't choose, call 1-800-MEDICARE. For the real 2027 deadlines, see plans ending in 2027.
After a hurricane or flood
After storms like Hurricane Helene, people replacing lost medicines, oxygen and medical equipment can be targets. Get replacements through your own doctor, pharmacy and plan, and be wary of anyone who knocks on the door or calls offering equipment in exchange for your Medicare number. See hurricanes, floods and Medicare in North Carolina.
How do I report Medicare fraud in North Carolina?
| What happened | Who to contact |
|---|---|
| Medicare billing you don't recognize, or a suspicious call | 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), or report online at Medicare.gov |
| Any Medicare fraud | HHS Office of Inspector General: 1-800-HHS-TIPS (1-800-447-8477), or oig.hhs.gov |
| Help deciding whether it's fraud, and reporting it | Senior Medicare Patrol, national line: 1-877-808-2468 (smpresource.org) |
| Fraud involving a Medicare Advantage or Part D plan | I-MEDIC: 1-877-7SAFERX (1-877-772-3379) |
| Fraud by an NC Medicaid provider, or abuse of a patient in a Medicaid-funded facility | NC Department of Justice, Medicaid Investigations Division: (919) 881-2320, or online reports |
| NC Medicaid eligibility fraud or other program abuse | NCDHHS Medicaid fraud tip line: 1-877-362-8471, or your county Department of Social Services |
| Insurance fraud by an agent, a company or anyone else | NCDOI Criminal Investigations Division: 919-807-6840, or 888-680-7684 from within North Carolina; report online (reports can be anonymous) |
| Scam calls, robocalls and other consumer fraud | NC Department of Justice, Consumer Protection: 1-877-5-NO-SCAM (1-877-566-7226); in Spanish 919-716-0058 |
| An older or disabled adult being exploited, abused or neglected | Adult Protective Services at your county Department of Social Services |
When you call, have your Medicare number, the provider's name, the date of service and the statement or notice in front of you.
About the Senior Medicare Patrol
The Senior Medicare Patrol (SMP) helps people with Medicare, their families and caregivers prevent, detect and report health care fraud, errors and abuse. It is funded by the federal Administration for Community Living. The national SMP line, 1-877-808-2468, routes you to help; use it for fraud questions, not for choosing a plan.
How can I protect myself?
- Read every statement. Create a secure account on Medicare.gov to see Original Medicare claims as soon as they're processed, and read your plan's Explanation of Benefits.
- Keep a calendar. Write down doctor visits, tests and equipment deliveries to compare with your statements. Look for things you didn't get, things billed twice, and services your doctor didn't order.
- Hang up on cold calls. Don't talk to callers about tests, braces, supplies, new Medicare cards or plan changes. Call 1-800-MEDICARE yourself if you're unsure.
- Refuse deliveries you didn't order. Send them back and report them.
- Check agents. Before you share information with someone selling a Medicare plan, confirm their North Carolina license.
- Help a parent. Set up their Medicare.gov account together and review statements monthly. See helping a parent with Medicare.
If a scam left you in the wrong plan
If you were enrolled in a plan you didn't choose, call 1-800-MEDICARE first. Once that is sorted out, a licensed insurance agent who works with Benefits Life can explain plans from the companies they work with and when you can change, at no cost to you. You can request a call from a licensed insurance agent or find an independent licensed insurance agent. For appeals and other official contacts, see Medicare appeals in North Carolina and North Carolina Medicare contacts.
Sources
- Medicare.gov — Reporting Medicare fraud and abuse
- Medicare.gov — Medicare Summary Notice
- HHS Office of Inspector General — Report fraud
- HHS-OIG — Fraud alert: genetic testing scam
- HHS-OIG — Fraud alert: nationwide brace scam
- HHS-OIG — Special fraud alert: telemarketing by medical equipment suppliers (PDF)
- SMP National Resource Center
- NC Department of Justice — Health fraud (Medicaid Investigations Division)
- NCDHHS — Hotlines (Medicaid fraud tip line)
- NCDHHS — Adult Protective Services
- NC Department of Insurance — Report insurance fraud
- eCFR — 42 CFR 422.2264, beneficiary contact (unsolicited contact rules)
Frequently asked questions
Is someone calling about a new Medicare card a scam?
Almost always. Medicare says it will never call to sell you anything and calls asking for personal information only in limited situations, such as returning a call you made. Hang up, don't confirm any information, and report the call to 1-800-MEDICARE. You can print an official copy of your card from your Medicare.gov account.
How do I read my Medicare Summary Notice?
With Original Medicare, the Medicare Summary Notice comes every four months if you had services. For each item, check the date, the provider and the service against your own calendar, and look at what Medicare paid and what you may owe. It isn't a bill. If you see something you didn't get, call the provider first, then 1-800-MEDICARE.
Where do I report Medicaid fraud in North Carolina?
Report fraud by a Medicaid provider, or abuse of a patient in a Medicaid-funded facility, to the NC Department of Justice's Medicaid Investigations Division at (919) 881-2320 or online. Report fraud by someone receiving Medicaid to the NCDHHS Medicaid fraud tip line, 1-877-362-8471, or your county Department of Social Services.
Who investigates fraud by an insurance agent in North Carolina?
The North Carolina Department of Insurance's Criminal Investigations Division, at 919-807-6840 or 888-680-7684 from within North Carolina, or online. Report Medicare plan sales problems to 1-800-MEDICARE as well, and file a complaint about the agent with NCDOI.
Medicare in your North Carolina county
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