Has Your Doctor Been Flagged for Medicare Fraud? Here’s How to Tell

Medicare spent roughly $1.23 trillion in 2025, with improper payments totaling about $57 billion in claims involving missing paperwork, wrong recipients, or incorrect amounts. Real fraud is separate. CMS defines it as knowingly deceiving, concealing, or misrepresenting facts to secure money or property from a federal healthcare program. In 2025 alone, a nationwide crackdown alleged $14.6 billion in intended losses, followed by another $1.8 billion in overpayments uncovered during the first half of 2026.

OpenMedicare analyzed a decade of official billing data across a $940 billion stream and flagged $400 million in abnormal claims across 500 providers.

Fraudulent Medicare claims can hurt your wallet and your health. If you have traditional Medicare without a supplement, a fraudulent claim on Part B costs you 20% coinsurance for a service that never happened, according to Jason Gerstenberger of Insured With Jason. A fraudulent claim can also block legitimate care. If Medicare's records show you already received a service due to fraud, your claim for the same service gets denied.

Medical harm is real. In February 2025, a New York doctor was convicted of submitting fraudulent claims to Medicare for unnecessary lab tests and orthotic braces, resulting in more than $24 million in fraudulent claims. He also received tens of thousands of dollars in illegal kickbacks and bribes. One Medicare beneficiary testified to Congress that she was denied physical therapy for a shoulder issue in July 2024 because Medicare showed she was enrolled in a hospice she had never heard of. The doctor listed on the hospice paperwork was a surgeon whose identity had been stolen.

To check if your doctor has been flagged, you can search OpenMedicare, which covers about 1.7 million providers across all 50 states. You can also check the Office of Inspector General exclusions list at https://oig.hhs.gov/exclusions/ or Medicare's Care Compare at https://www.medicare.gov/care-compare/.

If you spot suspicious claims, request an itemized list of every service billed in your name and compare it with the visits you actually had. Report suspected fraud by calling 1-800-MEDICARE or the HHS-OIG hotline at 1-800-HHS-TIPS (1-800-447-8477). Monitor your Medicare Summary Notices and credit reports for claims you did not order.