From Kiplinger · · 1m 30s
Has Your Doctor Been Flagged for Medicare Fraud?
Check if your doctor is on Medicare's fraud list with these steps.
In brief
Check if your doctor is on Medicare's fraud list with these steps. Patients can verify if their doctor is flagged for Medicare fraud by checking OpenMedicare's list, reviewing claims, and reporting suspicious activity to Medicare. Originally reported by Kiplinger.
Medicare Fraud Overview
Medicare costs $1.23 trillion annually for 70 million Americans with $57 billion in improper claims.
Real Fraud Impact
CMS reported $14.6 billion in intended losses and $1.8 billion in overpayments from 2025 to early 2026.
Doctor Flagged Cases
OpenMedicare flagged $400 million in abnormal claims across 500 providers in 2025.
How Fraud Hurts Patients
Patients may face denied care, surprise bills, or medical equipment they never requested.
Real-Life Fraud Example
A 2025 New York doctor was convicted of $24 million in fraudulent lab tests and braces claims.
Patient Impact
Fraudulent claims can result in 20% extra costs for patients without supplemental insurance.
Fraud Detection Steps
Check OpenMedicare's list of 1.7 million providers across all 50 states and specialties.
Reporting Fraud
Report suspected fraud via Medicare's hotline, online tools, or the HHS-OIG fraud reporting page.
Fraud Prevention Tips
Review Medicare Summary Notices and compare billed services with actual visits.
When to Report
If you see tests, procedures, or equipment you never received, call 1-800-MEDICARE or report online.
Why Most Claims Are Legitimate
Most Medicare claims are legitimate; coding errors are more common than intentional fraud.
The short version
Patients can verify if their doctor is flagged for Medicare fraud by checking OpenMedicare's list, reviewing claims, and reporting suspicious activity to Medicare.
