Protecting Your Medicare and Medicaid Benefits from Fraud and Exploitation in FL

Florida ranks among the top three states in the nation for healthcare and Medicare-related fraud investigations, according to the U.S. Department of Justice and the HHS Office of Inspector General (OIG).

Criminals know that many older adults trust authority figures and may not recognize warning signs.

By knowing the tactics scammers use, you or your loved ones can avoid becoming a victim of Medicare fraud.

How Medicare Fraud Targets Florida Seniors

Medicare fraud happens when someone intentionally deceives Medicare to receive unauthorized benefits or payments.

South Florida operates as ground zero for healthcare fraud. Federal investigators describe multi-billion-dollar schemes running from call centers throughout the region.

Common fraud scenarios:

• Billing for services never provided
• Sending unnecessary medical equipment and billing Medicare
• Using your Medicare number to submit fake claims
• Offering “free” tests that aren’t medically necessary
• Charging for more expensive services than actually provided

According to the HHS OIG, Medicare loses roughly $50 billion each year to fraud, waste, and abuse.

Red Flags Every Senior Should Recognize

Fraudsters count on confusion, urgency, and trust. Recognizing warning signs stops scams before they cause harm. Red flags may involve:

1. Unsolicited Contact About Your Benefits

Medicare will never call you out of the blue asking for personal information. If you receive unexpected calls, texts, or emails claiming to be from Medicare, treat them with suspicion.

What Medicare actually does:

• Sends written notices by mail before calling
• Only calls if you’ve left a message or filed a complaint
• Never asks for payment over the phone
• Doesn’t threaten to cancel your benefits

What scammers do:

• Call without warning, demanding immediate action
• Use phrases like “act now” or “last chance”
• Claim benefits will be canceled unless you confirm the information
• Spoof caller ID to appear legitimate

Again, if someone contacts you claiming to represent Medicare and asks for sensitive information, end the conversation.

2. Requests for Your Medicare Number

Your Medicare number should be treated like a credit card number. Only share it with your:

Doctor, hospital, pharmacy, or other trusted healthcare providers billing for services you actually received

Medicare cards are free and mailed automatically. You don’t need to provide information over the phone to receive one.

3. Offers of Free Medical Equipment

One widespread scam involves mailing orthotic braces, glucose monitors, or genetic testing kits to Medicare beneficiaries who didn’t order them.

The items arrive “free,” but Medicare gets billed thousands of dollars.

If you receive medical equipment you didn’t order, someone is likely using your Medicare number to commit fraud.

4. Unusual Payment Requests

Legitimate healthcare providers bill Medicare directly. Any request for gift cards, wire transfers, or cryptocurrency signals a scam.

Types of Medicare Scams in Florida

1. Genetic Testing Fraud

This billion-dollar scheme has hit Florida particularly hard. Scammers contact Medicare beneficiaries offering “free” genetic testing for cancer or heart disease. They send testing kits by mail and convince seniors to provide DNA samples.

What Medicare does:

Medicare only covers genetic tests that are medically necessary and ordered by your treating physician.

Nationwide, losses from genetic testing fraud since 2018 are estimated at over $2 billion.

2. Durable Medical Equipment Scams

Fraudsters ship knee braces, back braces, or wheelchairs to Medicare recipients without legitimate doctors’ orders. Medicare gets billed for expensive equipment the beneficiary didn’t need and often can’t use.

Federal and state investigators continue to target DME scams in Florida. Recent arrests have been linked to $1 billion in fraudulent claims filed between 2020 and 2024.

3. Telemarketing and Robocalls

Automated calls and live telemarketers contact seniors pretending to represent Medicare, offering lower costs or upgraded coverage. The real goal is to collect Medicare numbers to commit fraud.

These operations often run from Florida call centers using illegally obtained personal data to target vulnerable older adults nationwide.

4. Medicare Advantage Plan Scams

During annual enrollment periods, con artists pressure people to switch plans or provide information to “verify” coverage.

Beginning in 2025, Medicare Advantage marketing calls must include:

• A recorded disclaimer
• Agent ID number

Legitimate plans never require immediate decisions or threaten loss of benefits.

How to Protect Yourself

Prevention works better than fixing fraud after it happens.

1. Guard Your Medicare and Social Security Numbers

Don’t carry your Medicare card in your wallet unless going to a medical appointment.

What’s safe to share:

• Give your number only to doctors and pharmacies providing your care
• Verify you’re speaking with legitimate providers before sharing information
• Check that websites are official before entering details

Never share:

• Over the phone, unless you initiated the call
• In response to unsolicited emails or texts
• With door-to-door salespeople or telemarketers

Your Medicare number gives access to thousands of dollars in potential fraudulent billing. Protecting it with the same care you’d give to banking information isn’t paranoia. It’s common sense.

2. Review Your Medicare Summary Notice

Medicare mails a summary of services billed under your number every three months. You can also access this online at Medicare.gov.

What to check:

• Dates match when you saw providers
• Listed services match what you received
• No duplicate charges appear
• You recognize all providers listed

You can also sign up for electronic Medicare Summary Notices (eMSNs) through your Medicare.gov account for faster alerts.

The Senior Medicare Patrol provides free My Health Care Tracker tools to help you keep accurate records.

3. Verify Before You Trust

Scammers fake caller IDs and create official-looking websites. Always verify independently.

Verification steps:

• Call Medicare directly at 1-800-MEDICARE to confirm any claims
• Look up phone numbers yourself rather than using the numbers callers provide
• Visit Medicare.gov rather than clicking links in emails
• Check with your doctor before accepting offers of equipment or testing

Spend five minutes reviewing your statements every quarter. It may very well catch fraud worth thousands of dollars.

Where to Report Medicare Fraud in Florida

Multiple agencies investigate fraud and assist victims. Be sure to contact the agencies below the moment you come across or are suspicious of an incident that may be tied to Medicare fraud:

Report to Medicare

• Call 1-800-MEDICARE (1-800-633-4227)
• File reports online at Medicare.gov
• For Medicare Advantage or Part D plans, contact I-MEDIC at 1-877-7SAFERX (1-877-772-3379)

Contact Florida’s Senior Medicare Patrol

This free service operates statewide through Florida’s Area Agencies on Aging

SMP counselors help you:

• Understand statements
• Determine if fraud occurred
• Assist with reporting
• Provide education about prevention

File with Florida’s Attorney General

The Attorney General’s Office operates a Senior Protection Team dedicated to fighting fraud against seniors

Call 1-866-966-7226 or file complaints online at MyFloridaLegal.com

Alert Local Law Enforcement

If you’ve lost money or provided financial information to scammers, contact local law enforcement immediately

File a police report

You can also report large-scale or organized fraud directly to:

HHS OIG Hotline: 1-800-HHS-TIPS (1-800-447-8477)

Reporting fraud helps more than just you. Every complaint you file helps investigators identify patterns, track criminal operations, and stop scammers from targeting other seniors across Florida.

Helping Family Members Stay Safe

Many caregivers worry about elderly parents falling victim to fraud.

Steps family members can take:

• Help create a Medicare.gov account to review claims online together
• Check for suspicious equipment or unexpected packages at their home
• Offer to review Medicare Summary Notices when they arrive
• Discuss common scams so loved ones recognize them
• Stay alert for signs of financial exploitation

Signs a senior may have been targeted include unexplained charges, receiving medical equipment they didn’t order, or new “friends” offering help with benefits.

Florida Legal Protections

Florida law provides specific protections for seniors. Under Florida Statutes Section 825.103, criminal exploitation of elderly or disabled persons can result in felony charges with significant prison time and fines.

The Florida Department of Elder Affairs coordinates elder abuse prevention programs statewide. If you suspect financial exploitation:

Call the Florida Abuse Hotline: 1-800-96-ABUSE (1-800-962-2873). This toll-free number operates 24 hours a day.

Comprehensive Planning Beyond Fraud Prevention

Medicare fraud can derail carefully laid plans and drain resources meant to provide for your care. Protecting yourself from it is just one piece of planning as you age.

Our team helps Florida families coordinate healthcare benefits with asset protection and long-term care planning. Contact us through our website to discuss comprehensive planning and protection.

Stay informed, stay alert, and know where to turn for help.

This blog post is for informational purposes only and does not constitute legal advice. Medicare regulations change frequently, and eligibility is determined on a case-by-case basis.