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  • Geebo 9:00 am on November 10, 2025 Permalink | Reply
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    America’s $14.6B Healthcare Fraud Crackdown Explained 

    By Greg Collier

    In June 2025, the U.S. Department of Justice announced the largest healthcare fraud takedown in American history—charging 324 defendants, including doctors, medical business owners, and executives across 50 federal districts.

    The alleged schemes totaled more than $14.6 billion in intended losses, much of it tied to Medicare, Medicaid, and COVID-19 relief programs.

    While the headlines focus on the massive numbers, the real story is how fraudsters turned public health programs—designed to help the sick and elderly—into billion-dollar criminal enterprises.

    What’s Going On:

    This nationwide enforcement sweep—coordinated by the Health Care Fraud Strike Force and HHS-OIG—uncovered multiple overlapping schemes, including:

    • Telemedicine & Lab Fraud: Criminal networks billed the government for fake telehealth sessions and unnecessary lab tests never performed.
    • Pharmacy Kickbacks: Pharmacies paid illegal referral fees for patient data to over-prescribe controlled substances or expensive specialty drugs.
    • Durable Medical Equipment Scams: Fraudulent suppliers billed Medicare for wheelchairs, braces, or monitors that were never delivered.
    • COVID-Relief & Opioid Fraud: Some defendants misused pandemic programs to launder funds or obtained opioids under false pretenses for resale.

    Authorities say the operation prevented over $4 billion in payments on false claims and revoked billing privileges for hundreds of providers before more damage occurred.

    Why It’s Effective:

    Healthcare fraud succeeds because it exploits complexity and trust:

    • Complex Billing Systems: Medicare and Medicaid process millions of claims daily—fraudulent invoices blend in easily.
    • Blind Trust in Providers: Patients rarely question a doctor’s orders or medical billing.
    • Limited Oversight Bandwidth: Agencies under pressure to process claims fast can miss red flags.
    • High Dollar Incentives: Each false claim can yield thousands—creating lucrative opportunities for organized crime groups.

    It’s not always shadowy hackers behind these crimes—sometimes it’s insiders, executives, or licensed professionals misusing legitimate systems for profit.

    Red Flags:

    Whether you’re a patient, healthcare worker, or caregiver, stay alert for:

    • Medical bills or claims for services you didn’t receive.
    • Unknown providers listed on insurance or Medicare statements.
    • “Free medical equipment” offers requiring your personal or insurance info.
    • Unsolicited calls or emails claiming to verify your Medicare number.
    • Duplicate billing or inconsistent charges for the same treatment.

    Quick Tip: If you get an Explanation of Benefits (EOB) that doesn’t match your memory of care, contact your insurer directly—not the number on the suspicious bill.

    What You Can Do:

    • Monitor your records: Check your insurance statements and Medicare Summary Notices monthly.
    • Protect your data: Never share your Medicare or insurance ID over the phone unless you initiated the call.
    • Freeze your credit: Prevent identity-based fraud before it starts.
    • Ask questions: If a provider insists on unnecessary procedures or “free” add-ons, it’s okay to say no.

    Report fraud fast: File reports through OIG.HHS.gov or the FTC’s ReportFraud.ftc.gov.

    For medical professionals:

    • Conduct regular billing audits.
    • Verify third-party vendors and billing partners.
    • Train staff to flag suspicious claims patterns.

    If You’ve Been Targeted:

    1. Contact your insurer or Medicare to flag unauthorized claims.
    2. Report the fraud to HHS-OIG or the National Healthcare Anti-Fraud Association (NHCAA).
    3. File an identity theft report at IdentityTheft.gov if your personal data was compromised.
    4. Document everything: Keep copies of fraudulent bills, letters, and communications.
    5. Notify your doctor or clinic: Fraud under your name may affect your medical record accuracy.

    Final Thoughts:

    Fraud in healthcare doesn’t just cost money—it erodes trust. Every fake claim drains resources meant for real patients.

    The DOJ’s $14.6 billion crackdown sends a strong message: fraudsters will be caught, but prevention starts with awareness at every level—patients, providers, and payers alike.

    Scammers will always chase complexity. But vigilance, education, and transparency are still the best medicine.

    Further Reading:

     

  • Geebo 8:00 am on October 14, 2025 Permalink | Reply
    Tags: , , medicare, ,   

    Scammers Targeting Open Enrollment 

    Scammers Targeting Open Enrollment

    By Greg Collier

    As open enrollment ramps up across the country, the Wisconsin Better Business Bureau is alerting consumers to a growing wave of fraudulent outreach targeting those updating Medicare or Healthcare.gov coverage. Although the warning originated in Wisconsin, the tactics being reported are not confined to any one state. Similar scams can occur nationwide whenever enrollment periods open and consumers are more likely to engage with unfamiliar contacts.

    The scheme typically begins with an unsolicited phone call or text message offering to assist with switching to a supposedly better or cheaper plan. The caller often insists that coverage is expiring or that immediate action is required. Once trust is gained, the individual is asked to confirm personal details such as a Medicare ID number or Social Security number. Some scammers go as far as verifying existing addresses to appear legitimate before advancing to sensitive questions.

    Reports show that these contacts can sound convincing. In some cases, the caller pretends to be checking on delivery of a new Medicare card. In other instances, text messages urge the recipient to call immediately to prevent cancellation of benefits. Once the conversation shifts toward payment requests or demands for account verification, the deception becomes clearer, although not always before harm occurs.

    What makes these scams particularly dangerous is what happens afterward. Stolen Medicare and Social Security numbers are not left unused. They can be employed to submit fraudulent medical claims in the victim’s name or redirect benefits without consent. In some cases, scammers initiate unauthorized plan changes that interfere with legitimate coverage. What begins as a brief interaction can lead to months of identity recovery, financial disputes, and corrections to medical records.

    The BBB emphasizes that legitimate assistance with plan enrollment is available through official channels only when the individual reaches out first. Licensed representatives for Healthcare.gov or Medicare are not permitted to charge for enrollment support and will not initiate contact unexpectedly. Any offer that relies on urgency, pressure, or promises of incentives in exchange for personal data should be seen as a serious warning sign.

    Even offers that appear generous, such as complimentary health screenings or gifts for switching plans, may be tactics designed to collect private information or filter out individuals based on health status. Some brokers try to identify only healthy applicants to manipulate their client pool, which is prohibited by Medicare rules.

    Consumers are encouraged to avoid clicking on links in suspicious messages or responding to unfamiliar communications about benefits. When in doubt, it is safest to visit Medicare.gov or Healthcare.gov directly rather than relying on third parties. Those who receive unexpected messages regarding employer-provided benefits should confirm legitimacy with their workplace before taking any action.

    Health care enrollment is already complex without the added risk of fraud. A cautious approach can prevent not only frustration but also long-term damage to personal identity, financial security, and access to care.

     

  • Geebo 8:00 am on October 6, 2025 Permalink | Reply
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    Shutdown Fuels Federal Impostors 

    Shutdown Fuels Federal Impostors

    By Greg Collier

    With the federal government shutdown creating uncertainty across the country, consumers are being urged to stay alert for scams that exploit the disruption. Officials in North Carolina recently issued a warning after seeing signs that criminals are using the shutdown to impersonate federal agencies and obtain personal or financial information. The concern is not limited to one state, since the agencies being mimicked operate nationwide and shutdown-related confusion affects people in every region.

    Past shutdowns have shown that scammers quickly adjust their tactics to match the moment. During previous funding lapses, people reported fraudulent claims about suspended Social Security checks, frozen food assistance, or threats that Medicare coverage would end unless immediate action was taken. In some instances, callers falsely offered help to federal workers or contractors struggling with missed paychecks, using the shutdown as cover to push loans or collect personal data.

    These schemes commonly arrive by phone, text message, or email and rely on pressure and urgency rather than credibility. Scammers often use caller ID spoofing or fake email domains to make their messages appear to come from federal agencies. That technology can make it difficult for people to immediately recognize that the communication is fraudulent.

    Government officials are emphasizing that legitimate agencies will not make unsolicited requests for sensitive information or demand payment through gift cards, wire transfers, or similar methods. Any unexpected outreach from someone claiming to represent a federal program should be treated with caution. People are encouraged to end the communication and reach out directly to the agency using verified contact information if there is reason to confirm anything.

    In North Carolina, the Consumer Protection Division of the state Department of Justice is continuing to accept fraud complaints during the shutdown. Other states have similar channels for reporting suspicious activity. Remaining cautious, especially when receiving messages that appear urgent or threatening, is one of the most effective ways to prevent financial or identity theft while the shutdown continues to create opportunities for exploitation.

     

  • Geebo 8:00 am on July 22, 2025 Permalink | Reply
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    Medicare Card Scam Targets Retirees 

    Medicare Card Scam Targets Retirees

    By Greg Collier

    A growing number of Medicare enrollees across the country are being targeted by phone scammers posing as representatives from the Centers for Medicare and Medicaid Services. These imposters claim to be contacting beneficiaries about updates to their Medicare cards, but their real objective is to steal personal information such as Medicare identification numbers.

    This scam is especially concerning for recent retirees who are still becoming familiar with how the Medicare system works. Criminals often rely on confusion or urgency to pressure individuals into handing over sensitive data. In many cases, they claim the changes are related to new policies involving Medicare or Social Security and that a new card must be issued. Some targets report being told that the card is changing to plastic, that it will contain a chip, or that it is being updated because of the new year. These claims are entirely false.

    The Centers for Medicare and Medicaid Services does not call enrollees out of the blue or request personal information unless a person has initiated contact. No new Medicare cards are currently being issued, and there are no plans to switch to chip-enabled cards or any other new format.

    The implications of giving away a Medicare number can be serious. Stolen Medicare credentials can be used by fraudsters to file false claims for medical equipment, medications, or procedures that never occurred. In extreme cases, criminals have enrolled unsuspecting beneficiaries into hospice care without their knowledge, fraudulently billing the federal government for end-of-life services while the individuals are still alive and healthy.

    Medicare enrollees should treat their Medicare card with the same level of care as a credit or debit card. If there is any concern that a number has been compromised, it is critical to contact Medicare at 1-800-MEDICARE to report the incident and, if necessary, request a new number.

    Protecting your Medicare number is essential to ensuring your benefits are not misused. If you receive an unsolicited call asking for personal Medicare information, hang up and verify the request directly with Medicare before taking any further steps.

     

  • Geebo 9:00 am on January 8, 2025 Permalink | Reply
    Tags: , , MBI, medicare, ,   

    New Medicare Cards Issued: Avoid Scams Now! 

    New Medicare Cards Issued: Avoid Scams Now

    By Greg Collier

    Medicare beneficiaries in several states are receiving new Medicare cards in 2025 due to a significant data breach. This initiative aims to protect personal information and reduce the risk of fraud for those affected. While this effort is legitimate, it has also created opportunities for scammers to exploit the situation.

    A data breach involving a Medicare contractor recently compromised sensitive information, including names, social security numbers, hospital account numbers, and Medicare Beneficiary Identifiers (MBIs). As a result, some individuals are being issued new Medicare cards with updated MBIs. The Centers for Medicare & Medicaid Services (CMS) is notifying affected beneficiaries directly through the mail, including detailed letters explaining the changes and providing the new cards.

    It is important to note that Medicare will never call beneficiaries to inform them about the issuance of new cards or to verify personal information. If you receive a phone call from someone claiming to be from Medicare and asking for your MBI or other personal details, it is likely a scam. Scammers often try to create a sense of urgency, claiming you need to confirm your new number immediately. If this happens, hang up and avoid sharing any personal information.

    In some cases, legitimate medical providers may contact you for your Medicare number, often in connection with billing issues. However, to ensure your security, it’s best to call them back using the official number listed on their website or correspondence. This extra step helps confirm the legitimacy of the request and protects your personal information.

    For beneficiaries receiving new cards, it is crucial to update your records and provide your new MBI to healthcare providers and insurers to avoid delays in claims processing. If you suspect you have misplaced your new card, you can request a replacement from Medicare directly.

    Protecting your Medicare information is essential in a time when scams are becoming increasingly sophisticated. By staying informed, you can ensure your personal details remain secure while navigating these changes.

     

  • Geebo 8:00 am on July 17, 2024 Permalink | Reply
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    Medicare is NOT issuing new plastic cards 

    Medicare is NOT issuing new plastic cards

    By Greg Collier

    Recently, many individuals have reported receiving phone calls about needing to update their Medicare cards to new plastic ones with chips, often accompanied by requests for personal details. Unfortunately, these calls are part of a scam that the Federal Trade Commission (FTC) has noted is currently seeing a spike.

    Medicare cards are paper, and the agency has no plans to issue plastic cards. Any call suggesting the need to upgrade to a plastic card is a clear red flag. Treat your Medicare card like a credit card. Never share your Medicare number over the phone, especially if you did not initiate the call. Medicare will never call you to verify your card number or request personal information.

    If you receive a call from someone asking for your Medicare number or offering a new card, hang up immediately. Then, call Medicare directly using the number on your official paperwork or their official website to verify if any changes are needed.

    Be cautious if a caller asks you to pay for a new card or offers additional benefits in exchange for personal information. Medicare cards are free, and any request for payment is a scam.

    If you believe you have been targeted by a Medicare scam, report it immediately to the FTC and your local authorities. Additionally, you can contact Medicare directly to report suspicious activity.

    Scammers are continually devising new ways to exploit vulnerable individuals. By understanding how Medicare operates and recognizing the signs of fraud, you can safeguard your personal information and benefits. Always verify calls claiming to be from government agencies and report any suspicious activity to protect yourself and others from falling victim to these scams.

     

  • Geebo 8:00 am on April 30, 2024 Permalink | Reply
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    Scammers prey on the elderly with hospice care fraud 

    Scammers prey on the elderly with hospice care fraud

    By Greg Collier

    The Federal Bureau of Investigation (FBI) has issued a stark warning about a disturbing trend in Medicare fraud involving the enrollment of unsuspecting individuals into hospice care, often without their knowledge or consent.

    Reports flooding into the FBI’s Houston office paint a troubling picture of scammers manipulating the healthcare system for their financial gain. The FBI says they have received a significant uptick in complaints.

    What sets this scam apart is its brazen exploitation of individuals nearing the end of their lives. Scammers, masquerading as healthcare providers, are enrolling predominantly elderly victims into hospice care unnecessarily. The repercussions are grave, both financially and medically, as victims find themselves saddled with exorbitant bills for services they neither wanted nor needed.

    The consequences extend beyond financial strain. Victims may experience delays or denials of essential medical care due to being erroneously enrolled in hospice. As the FBI emphasizes, this fraudulent activity can have dire, potentially life-threatening consequences, depriving individuals of timely access to vital healthcare services.

    Unraveling the intricate web of deceit reveals a network of collaborators complicit in this exploitation. Behind the scenes, unscrupulous healthcare providers, often aided by complicit physicians and recruiters posing as legitimate marketers or sales representatives, orchestrate these fraudulent enrollments.

    The FBI offers practical advice to shield yourself or a loved one from falling victim to such scams. If an unfamiliar caller solicits sensitive details, refrain from divulging any information or confirming existing data. Remember, legitimate healthcare providers will not initiate contact in such a manner.

    Telemarketing calls can serve as a gateway for fraudsters. If you receive an unsolicited call regarding healthcare services, exercise caution and promptly disconnect the call.

    By heeding the FBI’s cautionary advice, we can collectively combat Medicare fraud and safeguard the well-being of our communities’ most vulnerable members.

     

  • Geebo 9:00 am on November 28, 2023 Permalink | Reply
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    AI finds its way into Medicare scams 

    AI finds its way into Medicare scams

    By Greg Collier

    We are currently nearing the end of Medicare’s Open Enrollment period. This is the time of year when Medicare recipients can change their plan from the traditional Medicare coverage to a Medicare Advantage plan, or change back if they so desire. This is also the time of year when scammers specifically target Medicare eligible seniors with their scams.

    When it comes to scams, identity theft poses a significant risk to seniors, especially during Open Enrollment. Scammers often employ tactics such as impersonating government officials, adopting titles like ‘health care benefits advocate,’ to deceive victims. These fraudsters make enticing promises, assuring the victim of enrollment in equivalent or superior coverage at a reduced cost. To accomplish their scheme, the fraudulent agent requests the victim’s personal information, including their Medicare number.

    The stolen Medicare number becomes a tool for these scammers to commit Medicare fraud, involving unauthorized charges for procedures or items. This fraudulent activity has the potential to impact the victim’s benefits in the future. Additionally, scammers resort to high-pressure tactics, such as claiming that the victim’s benefits may expire if immediate information is not provided. In some cases, these deceptive calls may even display Medicare’s official phone number, adding an extra layer of trickery. It is crucial for seniors to be vigilant and cautious to protect themselves from falling victim to such identity theft scams during the Open Enrollment period.

    Though not strictly a scam, certain unscrupulous insurance brokers may exert undue pressure on seniors to switch to their company’s Medicare Advantage plan. While Medicare Advantage plans can offer advantages for some individuals, they may also have limitations that may not suit everyone’s needs. The decision to switch should be based on the individual’s personal healthcare requirements, yet some insurance agents may prioritize making a sale over the well-being of the patient.

    If contemplating a transition from Medicare to a Medicare Advantage Plan, it is essential to conduct thorough research on the potential benefits and drawbacks. Avoid succumbing to the tactics of salespersons, who may push for a decision that could lead to regret in the following year. Taking the time to make an informed decision ensures that the chosen healthcare plan aligns with individual needs and preferences.

    There is also another potential threat with this year’s Open Enrollment, and not surprisingly, it’s related to AI. Experts are warning that scammers could be using AI-generated voice programs to make scam phone calls sound more authentic. These calls could even be used to try to record a victim’s voice, which could then be used in other voice spoofing scams.

    It’s important to be cautious when receiving calls related to your Medicare plan. Legitimate Medicare plans typically contact their members if necessary, but if you ever feel uneasy during such calls, consider calling your insurance company’s official customer service number to verify the legitimacy of the communication.

    As a general rule, exercise caution about sharing your Medicare or Social Security number over the phone. Medicare and your insurance company already have your information on file and typically don’t need you to provide it again during unsolicited calls. This precaution helps protect you from potential scams or identity theft. Always prioritize your security and verify the authenticity of any calls before sharing sensitive information.

     

  • Geebo 8:00 am on June 27, 2023 Permalink | Reply
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    Medicare scammers don’t know you have Medicare 

    Medicare scammers don't know you have Medicare

    By Greg Collier

    Medicare scammers are some of the worst. There are few things more heinous than threatening the elderly with the health benefits they earned in life. Scammers often call their elderly victims, posing as Medicare, while trying to get the victim’s Medicare information. This way, the scammers can file fraudulent claims under the victim’s Medicare policy. The victim’s will often be told benign things like Medicare is issuing a new type of ID card. Or they’ll be threatened with the loss of their benefits if the victim doesn’t comply with the caller.

    Here’s something to keep in mind, though. Most of the time, Medicare scammers are calling people blind, hoping they have Medicare. For example, a man in Indiana receives up to 35 calls a day from Medicare scammers. Except, the man hasn’t reached the age when most people enroll in Medicare. The man believes the reason he keeps getting so many scam calls is because he did what you’re supposed to do with a phone, he answered it. Once scammers know that they’ve reached a legitimate number and there’s an actual person on the other end, they continue to spam that person with phone calls. This isn’t strictly for Medicare scammers, either, as many different types of scammers will employ the same calling technique.

    As far as Medicare scams themselves go, please keep this one piece of information in mind. Medicare will not call you on the phone, unless you called them first with some kind of issue or concern. Medicare will not call you, asking you for your Medicare number. They will also not call you to offer you discounts on medical equipment or supplies. If Medicare does need to communicate with you, they will do so exclusively by postal mail. Even if the caller ID says that it’s Medicare calling, unless you called them first, that’s not them.

     

  • Geebo 8:00 am on May 26, 2023 Permalink | Reply
    Tags: , , , medicare,   

    Scammers try last-minute Medicare fraud 

    By Greg Collier

    If you are a Medicare recipient and have recently received COVID tests you didn’t order, you might be the victim of Medicare fraud. With the Public Health Emergency around COVID being declared over this month, scammers have been sending COVID tests to Medicare recipients, while billing Medicare at close to $100 a pop. Victims have said they received multiple COVID tests from providers that were outside of their state.

    Now, some Medicare recipients may not think that this is a big deal. They might think they got free COVID tests while Medicare paid for it. So, what’s the big deal? Outside of their Medicare information being compromised, any kind of fraudulent charge billed to Medicare can have negative effects on a policyholder’s benefits.

    If a fraudulent charge goes undetected, the patient may be responsible for paying out-of-pocket for services or supplies they did not receive or need. Medicare has coverage limits for various services and supplies. Fraudulent charges can lead to unnecessary utilization of these benefits, causing patients to exhaust their coverage limits prematurely. If fraudulent claims are submitted using the patient’s Medicare information, it can lead to confusion in medical records and billing systems. This may result in delays, denials, or even the denial of legitimate claims, causing a disruption in the patient’s ongoing care and treatment plans. Lastly, fraudulent claims sent to Medicare increase healthcare costs in general.

    If you receive tests that you didn’t order, contact Medicare immediately at the customer service number on your Medicare card. To help prevent future fraud, policyholders should always review the Explanation of Benefits (EOB) statements they receive in the mail. These statements show how a claim was paid and to whom.

    Any suspicious charges or discrepancies should be reported to Medicare’s fraud hotline, so they can try to rectify the situation. Additionally, staying informed about common fraud schemes and protecting personal Medicare information can help reduce the risk of fraudulent activities.

     

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