Broker Check
Avoiding and Spotting Medicare Advantage Fraud

Avoiding and Spotting Medicare Advantage Fraud

March 25, 2024

A Medicare Advantage Plan, also known as “MA Plan” or “Part C,” is an approved Medicare plan that private companies offer. Unlike Original Medicare, where the government pays for Medicare benefits when you receive them, the government pays companies to cover your Medicare benefits.


There are several types of Medicare Advantage Plans, including Preferred Provider Organization plans (PPO), Health Maintenance Organization plans (HMO), Special Needs plans (SNPs), HMO Point-of-Service plans (HMOPOS), and Private Fee-for-Service plans (PFFS).


Unfortunately, some criminals prey on unsuspecting Medicare Advantage carriers through the use of a scam. Medicare fraud is a form of identity theft in which someone tries to defraud Medicare and steal someone else’s Medicare information. Former director of NCOA’s MIPPA Resource Center, Brandy Bauer, explains that most often, it is information provided by the customer used to commit identity fraud. Medicare and Medicaid fraud is estimated to cost taxpayers and the government over $100 billion annually.


Here are a few ways that scammers harm Medicare Advantage customers:


  • Criminals use the phone, email, text messaging, and snail mail to connect with potential targets.
  • They submit fake Medicare claims in the beneficiary’s name to obtain healthcare services, supplies, equipment, and even prescription drugs.
  • Unauthorized treatments can max out an enrollee’s benefits and charge copayments for services they didn’t receive.
  • Phony treatments on a person’s Medicare records can make it hard for providers to assess a patient’s actual medical history.
  • A scammer may say they are contacting you from Medicare and that you are “pre-approved” for a new healthcare plan.
  • Another tactic is that the scammer will threaten to cancel your Medicare account if you don’t verify your personal information or choose a new plan.


There are a seemingly unlimited number of tricks fraudsters use to steal your information, identity, and money. It is essential to take active steps to ensure your information is for your eyes only.


Here are some tips on how to avoid and spot a scam before becoming a victim:


  • Be wary of phone calls from people you don’t know, especially if they ask you for personal information.
  • Don’t open emails from people you don’t know. Like a phone call, be vigilant not to give out your personal information.
  • Take caution clicking on links that seem too good to be true.
  • Keep your software updated.
  • Periodically change your passwords.
  • Throw out mail you receive from people you don’t know.
  • Again, don’t give out personal information like your social security number.


Be proactive and consult a financial professional:


Many people believe that they could never be manipulated into giving up information to a scammer, however, they can be incredibly persuasive and as technology changes and develops, so do the scams. Getting help from a third party can ensure you are taking necessary measures to help mitigate unnecessary risk that comes with falling into a fraudster’s trap. Consider consulting a financial professional to help you monitor your Medicare Advantage plan and ensure your information remains as secure as possible.


Important Disclosures:

Content in this material is for educational and general information only and not intended to provide specific advice or recommendations for any individual.


All information is believed to be from reliable sources; however, LPL Financial makes no representation as to its completeness or accuracy.


5 Medicare scams to avoid in 2024 - LifeLock (

Senior Citizen Scams: 12 Common Types & How to Avoid Them (

How To Identify Medicare Scam Calls: Avoid These 9 Scams (

11474.pdf (

How to protect yourself from Medicare scams—and what to do if you become a victim | Fortune Well


This article was prepared by LPL Marketing Solutions

LPL Tracking # 517466