How To Spot, Report, and Avoid Health Insurance Scams

Health insurance provides an essential safety net in our health care system. Unfortunately, some people will take advantage of our desire for protection. They use scare tactics to get money and personal information from everyday people — especially older adults. They know how confusing and intimidating navigating the health care system is and use it for their gain.

Anyone can be the victim of an insurance scam. In recent years, health insurance scams have become more and more sophisticated. Scams can happen on the phone, online, or through social media. If you have questions about health care scams, talk to an experienced health insurance attorney for advice.

Common Health Insurance Scams

One of the best ways to protect yourself from health care fraud is to understand the different types of scams. Below are a few of the most common ways scammers might try to trick you out of your money or personal information.

Illegally Charging You for Help

Health insurance scammers might cold-call, text, or email, offering help for a small fee. They may say they are from your health insurance company or a government agency. This is almost always a scam. The people who provide legitimate advice on purchasing insurance plans are not allowed to charge a fee.

If you get a random call with an offer to help you navigate the health insurance marketplace, do not give them any financial information. If you need assistance, contact your insurance provider or government agency directly.

Ambulance Fraud

Ambulance fraud scams often involve posing as an insurance claims agent and creating fraudulent charges for ambulance transportation. They may even file a fake claim for an ambulance ride that never happened. This scam often happens to Medicare recipients who need regular medical transportation.

If you suspect someone has filed a false ambulance claim, you can report it to the Department of Health and Human Services under the False Claims Act.

Medical Identity Theft

Medical identity theft happens when someone steals your personal information and uses it to submit fake claims. Most often, they use stolen Social Security numbers or Medicare numbers. These thieves might also use other people’s information to obtain prescription drugs. You can avoid these scams by:

• Carefully reviewing medical bills and statements
• Reporting suspicious charges
• Not giving out your SSN or Medicare number over the phone or email
• Be wary of someone who offers free health services but asks for your health plan information

Fraudulent Discounts

Those who participate in health insurance fraud might try to entice you with discounts or bundles to get your information. But if you didn’t initiate the call, the person you’re talking to is not likely from the insurance company. If a deal for health services sounds too good to be true, it probably is.

Marketing Scams

Sometimes, scammers will go as far as creating a fake insurance company (or stealing the name of a real company) to sell counterfeit policies. They seem legit and have websites that resemble actual companies or government sites. These sites that offer alternatives to comprehensive health insurance are often scams. The same goes for supposed “health care sharing ministries.”

If you’re looking to buy insurance through the Health Insurance Marketplace, make sure you’re on HealthCare.gov or your state’s official marketplace website. Someone who tries to sign you up for a policy on a different site may be trying to scam you.

Medicare Fraud and Scams

Many health insurance scams target older people, especially those who rely on Medicare. These scammers are active during the open enrollment period. By calling Medicare beneficiaries and claiming they need a new card, a scammer can get valuable information. New Medicare cards get sent out automatically to the address the government has on file. There is no fee. Anyone claiming otherwise is pulling a scam.

If someone threatens to cancel your Medicare benefits if you don’t provide the personal information, hang up. Call 1-800-MEDICARE to find out the real status of your coverage. They can help you ensure your Medicare benefits are in order and file a consumer complaint.

There are similar scams with supplemental plans like Medicare Part D. Government regulations prohibit anyone from enrolling you in Medicare Part D unless you call them. If someone calls offering Medicare Part D, they are likely a scammer.

Fake Government Employees

Some health insurance fraud schemes have people posing as government employees. Similar to the IRS or fake arrest warrant scams, these people try to scare vulnerable folks into giving up information over the phone. They claim to represent the government and will threaten to take away your Medicaid or insurance coverage.

They might even have fake badge or ID numbers. They can sound official. Scammers also use caller ID spoofing systems to make it seem like they are calling from a government office. Just because your caller ID shows the call is coming from Medicare does not mean it’s true.

Keep in mind — government agencies won’t call you out of the blue asking for your personal information. They won’t ask for your credit card number, your Social Security Number, or bank information over the phone. Official correspondence will come in the mail.

If you worry about losing Medicare or government benefits, contact their agencies directly. Visit the official websites HealthCare.gov or Medicare.gov. Don’t click on links sent in an email or text message. They could take you to a fake website that can steal your financial information.

How To Avoid Health Insurance Scams

All of this might seem scary. But there are a few easy ways to make yourself a tougher target for health insurance scams. Make sure to protect your identity and verify who you’re talking to before offering personal information. Some red flags of a possible health care scam include:

• Unsolicited messages asking for sensitive information over the phone
• Making threats of losing your health coverage if you don’t pay immediately
• Asking for payment with gift cards or wire transfers
• Free offers needing a processing fee or administrative charge
• Medical discount plans where the salesperson can’t give you specific information

Reporting Health Insurance Scams

If you detect a scam relating to your insurance, call your insurance company right away. They should have a process for reporting scams. You can also report insurance scams to government agencies that handle these matters. You can report fraud to:

• The Federal Trade Commission at ReportFraud.ftc.gov
• 1-800-MEDICARE
• The National Health Care Anti-Fraud Association

Get Legal Help With Health Insurance Scams

If health insurance scammers ripped you off, it takes a lot of work to clean up the mess. Health care providers and insurance companies may still try to come after you for payment, even after you report fraud. A health insurance lawyer can review your situation and explain your legal options. Contact a health insurance lawyer for more information about what you can do about health insurance fraud.