CMS Blocks $3.4 Billion in Fraudulent Payments, But Scammers Target Older Adults Directly
New red flags emerge as beneficiaries are warned to actively watch for unsolicited calls for 'free' tests or products to protect their personal information.
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The Centers for Medicare & Medicaid Services (CMS) announced they are barring 11 medical supply companies from future Medicare Advantage payments due to suspected fraudulent billing practices totaling more than $3.4 billion [c5]. I saw that headline while waiting for my mom’s prescription refill, and my first thought wasn't about the billions. It was about the calls my mom gets, the ones offering 'free' diabetic test strips or miracle pain creams. I usually tell her to hang up, but this time I actually pulled over into a parking lot to text her, asking if anyone had called about her Medicare number recently. It’s this whole framing of Medicare fraud being a government problem, a numbers game of billions blocked, that gets me. It lets everyone else off the hook. The official line, like what the FBI often says, is that awareness and conversation are key to prevention [c1], and that criminals exploit older adults through increasingly sophisticated impersonation [c3]. But that’s like telling someone to just ‘be aware’ of a tidal wave. The industry response is usually along the lines of, 'Nobody gives up their information unless they know exactly who they're talking to and want to' [c3]. That’s the problem. When someone calls offering something that sounds good, and they already have your name and a few details, it’s not about knowing who they are; it’s about the trust they build in those few minutes. The real kill shot isn't a warning; it's a concrete step. The FBI’s Internet Crime Complaint Center (IC3) reported older Americans lost over $4.8 billion to fraud in 2024 [c1], and that number keeps climbing. The government can block billions, but what about the individual losses that chip away? The actual fix is to get ahead of the scammer's tactics. If you’re helping an older adult manage their healthcare, ask their pharmacy about setting up a 'medication synchronization' program. It means all their refills are ready at once, reducing the need for unexpected calls about prescriptions or supplies.
The direct answer
While CMS is actively blocking billions in improper Medicare payments from fraudulent companies [c4, c5], a significant portion of Medicare fraud still directly impacts beneficiaries. Scammers are increasingly using tactics like unsolicited calls offering "free" medical products or tests in exchange for personal information, including Medicare numbers [c6, c7, c8]. The FBI notes that older adults lost over $4.8 billion to fraud in 2024 alone
In recognition of National Senior Fraud Awareness Day, #FBI Nashville reminds families, caregivers, and communities that awareness and conversation are key to prevention. Older Americans lost more than $4.8 billion to fraud in 2024, according to the FBI’s Internet Crime…
— FBI Nashville link
. It’s crucial for individuals to recognize these new red flags and proactively protect their personal data, as these schemes can lead to medical identity theft and fraudulent billing under their name
"Be aware of unsolicited requests for your Medicare information, even if they are accompanied by offers of “free” COVID-19 tests or supplies or an email or call by someone claiming to be a representative from Medicare or the Department of Health and Human Services. Scammers may use your Medicare information to submit false medical claims for unrelated, unnecessary, or fictitious services."
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The Evolving Tactics of Medicare Scammers
Scammers are adapting their methods to directly target older adults, moving beyond simple impersonation. The Federal Communications Commission's Office of the Inspector General warns about unsolicited requests for Medicare information, often accompanied by offers of "free" COVID-19 tests or supplies
"Be aware of unsolicited requests for your Medicare information, even if they are accompanied by offers of “free” COVID-19 tests or supplies or an email or call by someone claiming to be a representative from Medicare or the Department of Health and Human Services. Scammers may use your Medicare information to submit false medical claims for unrelated, unnecessary, or fictitious services."
. These tactics aim to gather personal data, including Medicare numbers, which are then used to submit false claims for unnecessary or fictitious services
"Be aware of unsolicited requests for your Medicare information, even if they are accompanied by offers of “free” COVID-19 tests or supplies or an email or call by someone claiming to be a representative from Medicare or the Department of Health and Human Services. Scammers may use your Medicare information to submit false medical claims for unrelated, unnecessary, or fictitious services."
. The FBI has noted that criminals are using increasingly sophisticated impersonation techniques
#FBI Jacksonville joined our partners with @JSOPIO and the Citizens Academy Alumni Association to talk about elder fraud. According to the FBI’s Internet Crime Complaint Center (IC3), criminals continue to exploit older adults through increasingly sophisticated impersonation…
— FBI Jacksonville link
. This means that even seemingly legitimate offers can be a trap, potentially leading to medical identity theft and confusion about one's health records
"They promise “free” tests in exchange for your Medicare or personal health insurance info, but it's a trap. What seems like a harmless test could lead to medical identity theft, false insurance claims, and confusion about your health."
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Billions Blocked, But What About Individual Harm?
While CMS's efforts to prevent improper payments are substantial, with over $1.6 billion blocked in lab payments during one administration
"CMS said its enforcement efforts have resulted in blocking more than $1.6 billion in possibly improper Medicare lab payments throughout President Trump's administration."
and another $3.4 billion in suspected fraudulent billing practices identified for future prevention
"As part of the White House Anti-Fraud Task Force's ongoing efforts to crush fraud in the healthcare system and protect taxpayer dollars, the Centers for Medicare & Medicaid Services (CMS) has identified and is barring 11 medical supply companies with more than $3.4 billion in suspected fraudulent billing practices in 2025 and 2026 from receiving future Medicare Advantage (MA) Part C and Part D payments."
, these figures represent a fraction of the overall financial landscape of fraud. The FBI's Internet Crime Complaint Center (IC3) reported that older Americans lost more than $4.8 billion to fraud in 2024
In recognition of National Senior Fraud Awareness Day, #FBI Nashville reminds families, caregivers, and communities that awareness and conversation are key to prevention. Older Americans lost more than $4.8 billion to fraud in 2024, according to the FBI’s Internet Crime…
— FBI Nashville link
. This stark contrast highlights that while large-scale corporate fraud is being addressed, individual losses continue to mount, often stemming from direct interactions with scammers who exploit personal vulnerabilities.
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The Role of Beneficiaries in Fraud Prevention
The FBI emphasizes that awareness and conversation are key to prevention, particularly for older adults and their caregivers
In recognition of National Senior Fraud Awareness Day, #FBI Nashville reminds families, caregivers, and communities that awareness and conversation are key to prevention. Older Americans lost more than $4.8 billion to fraud in 2024, according to the FBI’s Internet Crime…
— FBI Nashville link
. Medicare itself states that it will not call beneficiaries to offer products or services, nor will it ask for personal information like a Medicare number over the phone
"If you get a call from someone claiming to be from Medicare, or working on behalf of Medicare, it's a scam! Medicare isn't calling to offer products or services of any kind. Don't confirm your Medicare number or give them any of your personal information; they may use it to bill Medicare for things like genetic tests or braces."
. Beneficiaries are urged not to confirm their Medicare number or provide any personal details if contacted unsolicited, as this information can be used to bill Medicare for services never received
"If you get a call from someone claiming to be from Medicare, or working on behalf of Medicare, it's a scam! Medicare isn't calling to offer products or services of any kind. Don't confirm your Medicare number or give them any of your personal information; they may use it to bill Medicare for things like genetic tests or braces."
. Proactive vigilance, including questioning unsolicited offers and verifying caller identity, is essential to protect against medical identity theft and fraudulent billing.
Common mistakes
- Focusing solely on large-scale corporate fraud.
While CMS blocking billions in improper payments is significant [c4, c5], it overshadows the direct financial and medical identity theft experienced by individual beneficiaries, who lost over $4.8 billion in 2024 [c1]. - Presenting fraud prevention as solely a government responsibility.
The FBI and CMS emphasize the need for beneficiaries to be aware of red flags like unsolicited calls for 'free' products or services [c6, c7, c8], highlighting that individual vigilance is a critical layer of defense. - Using vague warnings instead of concrete actions.
Generic advice like 'stay vigilant' is insufficient. The article needs to provide specific steps, such as verifying calls directly with Medicare or pharmacies, to empower readers.
In recognition of National Senior Fraud Awareness Day, #FBI Nashville reminds families, caregivers, and communities that awareness and conversation are key to prevention. Older Americans lost more than $4.8 billion to fraud in 2024, according to the FBI’s Internet Crime…
— FBI Nashville link
, it underscores that while government agencies are intervening against large-scale operations, individual beneficiaries remain vulnerable to sophisticated scams that exploit trust. The challenge is bridging the gap between macro-level fraud prevention and micro-level personal protection.
Frequently asked
What are the new red flags for Medicare fraud targeting older adults?
Be wary of unsolicited calls offering 'free' medical tests or products, or requests for your Medicare number to receive a 'new' card; Medicare does not make such calls.
How does Medicare fraud impact beneficiaries directly?
Scammers use stolen Medicare information to bill for unnecessary services, leading to medical identity theft, confusion in health records, and potential financial loss for the beneficiary.
What is CMS doing about Medicare fraud?
CMS is actively identifying and barring companies engaged in suspected fraudulent billing practices, preventing billions in improper payments from reaching them.
Who can I contact if I suspect Medicare fraud?
You can report suspected fraud to Medicare directly, or contact the FBI's Internet Crime Complaint Center (IC3) or your local FBI field office.
Sources
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