If someone has gotten hold of your Medicare number, call 1-800-MEDICARE (1-800-633-4227) right away to report it and ask for a new Medicare Beneficiary Identifier. Knowing what to do if someone gets your Medicare number matters because the number can be used to bill for services you never received, fill prescriptions in your name, and put false information into your medical file. You are generally not liable for fraudulent charges, and the replacement number is free.
Make the Calls in the First Hour
Speed matters. The longer a stolen number circulates, the more fraudulent claims stack up and the harder cleanup gets. Work through these calls in order.
Start with 1-800-MEDICARE. Have your card or number ready if you still have it, along with any Medicare Summary Notices showing suspicious charges. The representative can flag your account, walk through recent claims with you, and start the process for a new number. If you have a Medicare Advantage Plan or a Part D drug plan, also call the Investigations Medicare Drug Integrity Contractor (I-MEDIC) at 1-877-7SAFERX (1-877-772-3379) to report the issue through that channel.1Medicare. Reporting Medicare Fraud and Abuse
Next, file a report with the Department of Health and Human Services Office of Inspector General, which investigates fraud in federal health programs. Call the OIG Hotline at 1-800-HHS-TIPS (1-800-447-8477) or submit a complaint at oig.hhs.gov/fraud/report-fraud/.2U.S. Department of Health and Human Services Office of Inspector General. Contact Us
Then go to IdentityTheft.gov. The FTC’s portal walks you through a personalized recovery plan for medical identity theft, asking questions about what happened and generating pre-filled letters and forms you can send to credit bureaus, healthcare providers, and debt collectors. You can update the plan and track progress over time.3Federal Trade Commission. What To Know About Medical Identity Theft Completing this report also qualifies you for an extended fraud alert on your credit file, which lasts seven years instead of one.4Federal Trade Commission. Credit Freezes and Fraud Alerts
Finally, ask 1-800-MEDICARE for a referral to your local Senior Medicare Patrol. SMPs are federally funded programs in every state, and a counselor can review your claims with you one-on-one, help you understand what happened, and refer your case to the right state and federal agencies for investigation.5Senior Medicare Patrol Resource Center. What SMPs Do
Getting a New Medicare Number
CMS handles all requests to change a Medicare Beneficiary Identifier, and calling 1-800-MEDICARE starts the process. A new, randomly generated 11-character code will replace the compromised one.6Social Security Administration. New Medicare Numbers and Number Change Requests Confirm that your mailing address on file with Social Security is current so the new card reaches you. A replacement card generally arrives within about 30 days.7U.S. Department of Health and Human Services. How Do I Get a Replacement Medicare Card
Your coverage does not lapse while you wait. If you need care during the gap, providers can verify your eligibility through their billing systems using your name and date of birth. Once the new card arrives, give the number to every provider, pharmacy, and supplemental insurer you deal with.
What You’ll Owe for Fraudulent Charges
This is the part that keeps people up at night, and the answer is reassuring. Under federal rules, when a beneficiary did not know and could not reasonably have been expected to know that a service was not covered, and the provider knew or should have known, the beneficiary is not responsible for paying deductible or coinsurance charges related to the denied claim.8Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 30 – Financial Liability Protections In fraud cases, liability rests with the provider or the fraudster, not with you.
If a bill arrives for a service you did not authorize, don’t pay it. Contact Medicare and the billing provider to dispute the charge. If a debt collector contacts you about a fraudulent medical bill, the IdentityTheft.gov recovery plan includes pre-filled dispute letters you can send.3Federal Trade Commission. What To Know About Medical Identity Theft
Cleaning Up Your Medical Records
Fraudulent charges are a financial headache. The medical records problem can be worse. When someone uses your Medicare number to receive care, their diagnoses, prescriptions, and treatment history can end up in your file. A wrong drug allergy or a false diagnosis of diabetes could lead a future doctor to make dangerous treatment decisions based on someone else’s conditions.
Contact every doctor, clinic, hospital, pharmacy, and lab where the thief may have used your information. Explain the situation and request copies of the records associated with your Medicare number. You may need to submit request forms and pay copying fees. If a provider refuses to release records citing the thief’s privacy rights, ask for the patient representative or the person listed in the provider’s Notice of Privacy Practices and appeal the refusal.3Federal Trade Commission. What To Know About Medical Identity Theft
Once you identify fraudulent entries, submit a written request to each provider asking them to amend or remove the incorrect information. Include a copy of the record showing the error and explain why it’s wrong. Send the letter by certified mail so you have proof of delivery.3Federal Trade Commission. What To Know About Medical Identity Theft
Federal privacy rules give providers 60 days to act on an amendment request, with one possible 30-day extension if they provide a written explanation for the delay.9eCFR. 45 CFR 164.526 – Amendment of Protected Health Information A provider who corrects a record must also notify others who received the same incorrect information. If the provider denies your request, you have the right to file a written statement of disagreement that becomes part of your record.
Watching for Ongoing Misuse
Even after you report the theft and get a new number, monitor your account closely for at least a year. Fraudulent claims sometimes keep trickling in for months.
Medicare Summary Notices list every service billed to your account. Paper MSNs arrive every six months if you received any Part A or Part B services during that window.10Medicare. Medicare Summary Notice (MSN) Compare each notice against your own records of appointments and treatments. Red flags include services on dates you did not see a doctor, providers you have never visited, and equipment you never received.
Waiting six months for a paper notice is too slow when you are watching for fraud. Log into your account at Medicare.gov to view Original Medicare claims as soon as they are processed, and sign up for electronic MSNs under “My account settings” so you get an email link any month a claim goes through.11Medicare. Go Digital This is the single easiest thing you can do to catch fraudulent billing quickly.
Beyond your MSNs, pay attention to unexpected calls from providers you don’t recognize, collection notices for medical debts you know nothing about, and letters from your health plan confirming services or equipment orders you did not request.
Protecting Your Credit
Medicare fraud sometimes bleeds into broader identity theft, especially if the person who took your number also has your name, date of birth, or Social Security number. Two tools can protect your credit, and you only need to contact one of the three major bureaus (Equifax, Experian, or TransUnion) because whichever one you reach is required to notify the other two.4Federal Trade Commission. Credit Freezes and Fraud Alerts
A credit freeze is the stronger option. It blocks anyone, including you, from opening new credit accounts in your name until you lift it. Placing and lifting a freeze is free and does not affect your credit score. A fraud alert is lighter: it tells lenders to verify your identity before approving new accounts but does not block access to your credit report. An initial fraud alert lasts one year and can be renewed; an extended fraud alert lasts seven years but requires an identity theft report filed at IdentityTheft.gov or a police report.4Federal Trade Commission. Credit Freezes and Fraud Alerts
If there’s any chance the thief accessed financial information beyond your Medicare number, a freeze is the better choice. You can temporarily lift it whenever you need to apply for credit yourself.
Keeping It From Happening Again
Treat your Medicare card like a credit card. Keep it in a secure place at home and only carry it when you have a medical appointment. Shred documents that contain your Medicare number before throwing them away.
Medicare will never call, email, text, or message you on social media out of the blue to ask for your Medicare number, Social Security number, or bank account information. They will not try to sell you anything or ask you to pay for your card.12Federal Trade Commission. Avoid Scams During Medicare’s Open Enrollment Period The only time someone from Medicare will call and ask for personal information is if they are returning a call you initiated or following up on a fraud report you filed.1Medicare. Reporting Medicare Fraud and Abuse
Watch out for offers of “free” genetic testing or cancer screenings. Fraudsters set up booths at health fairs, community events, and senior centers, or show up at your door offering cheek swab tests. The test is a pretext to collect your Medicare number, which then gets used to bill Medicare for expensive lab work you never needed. Be suspicious of anyone other than your own doctor suggesting genetic testing, and never hand over your Medicare information at a public event.13U.S. Department of Health and Human Services Office of Inspector General. Fraud Alert – Genetic Testing Scam
Telehealth scams work similarly. Fraudsters bill Medicare for phone or video consultations that never happened, sometimes using your number to build a paper trail for additional fraudulent orders like prescriptions or equipment. If your MSN shows telehealth charges you don’t remember or providers you have never heard of, report them right away.
Only give your Medicare number to healthcare providers you trust, your state health insurance assistance program, or official Medicare representatives. If anyone contacts you offering free medical services or supplies in exchange for your number, that’s a red flag no matter how legitimate the offer sounds. When in doubt, hang up and call 1-800-MEDICARE yourself to verify whether the contact was real.1Medicare. Reporting Medicare Fraud and Abuse