How to Find Out Whether Your Doctor Has Been Linked to Medicare Fraud

Medicare fraud can damage both your health and your finances through fake care and bogus claims. Here is what to do if your doctor shows up on a flagged list.

Medicare is among the federal government’s biggest programs. After spending roughly $1.23 trillion in 2025, outlays are nearing $1.3 trillion this year to serve more than 70 million Americans. A share of that money is lost each year to so-called improper payments. According to the Centers for Medicare & Medicaid Services (CMS), about $57 billion in 2025 claims involved missing paperwork, the wrong recipient, or incorrect payment amounts, most of it tied to billing errors rather than intentional fraud.

Intentional fraud, though, is a far bigger issue. CMS describes it as knowingly deceiving, hiding, or misrepresenting facts to obtain money or property from a federal health program. In 2025, a nationwide crackdown alleged $14.6 billion in intended losses, and another $1.8 billion in overpayments was uncovered in the first half of 2026. Looking specifically at physician billing, OpenMedicare reviewed a decade of official data — examining every line, provider, and dollar in a $940 billion stream — and identified $400 million in unusual claims involving 500 providers.

Wondering whether your doctor has been flagged? Here’s how to check.

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How Medicare fraud hurts your wallet

Medicare was signed into law in 1965 to give older Americans health coverage they often could not obtain on their own. Hospital coverage under Part A became available automatically at age 65. Doctor coverage under Part B was optional and required a monthly premium. Medigap policies soon emerged to help cover deductibles, coinsurance, and copays. In 1997, Congress created Medicare Part C, now called Medicare Advantage, allowing private insurers to offer managed-care plans instead of traditional Medicare Parts A and B. A prescription drug benefit, Part D, was added in 2003. Because Medicare matters so much, fighting fraud, waste, and abuse is essential to its long-term stability.

Medicare fraud, waste, and abuse (pdf) takes money from taxpayers and drains resources that could otherwise go to beneficiaries’ care or other public priorities. When fraud hits Medicare, less money is available for the care you may need. You may be charged for services you never receive or for tests, medicines, and treatment you do not actually need. Doctors, pharmacies, and medical suppliers can make mistakes or poor decisions, but some have also been accused of stealing from Medicare.

For example, a New York doctor was convicted in February 2025 of filing fraudulent Medicare claims for unnecessary lab tests and orthotic braces (Department of Justice [DOJ], 2025a). The scheme generated more than $24 million in fraudulent claims. The doctor also received tens of thousands of dollars in illegal kickbacks and bribes.

Jason Gerstenberger of Insured With Jason says that if you have traditional Medicare without a supplement, a fraudulent Part B claim can cost you a real 20% share. “You end up paying coinsurance on a service that never happened.” He adds that if a scammer already billed Medicare under a patient’s number for something like a back brace, the legitimate item the patient later needs could be denied because the system shows it has already been provided.

How Medicare fraud can affect your health

Getting care from a fraudulent provider can lead to poor-quality, unnecessary, or even dangerous treatment. It can also block legitimate care. For example, if Medicare thinks you already received a service that has coverage limits, your claim may be rejected.

Many people do not realize they have been affected until months later, when they:

• Get surprise bills for care or services they never asked for
• Have coverage denied unexpectedly
• Learn about medical treatment they never received
• Receive medical equipment in the mail that they never ordered or wanted

Gerstenberger points to a hearing before the House Ways and Means Committee in which a Medicare beneficiary said she was denied physical therapy for a shoulder problem because Medicare showed her as enrolled in hospice, even though she had never heard of such enrollment. Her claims were denied for months while she kept paying premiums. The doctor listed on the hospice paperwork was actually a surgeon whose identity had been stolen.

Stacy Kemp Ferrari, a personal injury attorney at Kemp Law Group, described a similar case involving a 61-year-old patient who was told he needed $100,000 heart surgery. The patient questioned the recommendation because he was still functioning normally and did not feel as sick as the doctor suggested.

The patient turned to Kemp Law Group, which investigated and arranged a second opinion from an independent cardiologist. “After reviewing the tests, that cardiologist concluded the blockage did not require surgery,” Ferrari says. “If the patient had gone through with it, he may have faced complications such as a mild stroke or heart attack, which affect about 15% of patients over 60, plus three months of recovery, lost work, and likely extensive physical therapy.”

Common Medicare fraud risks

Scammers take advantage of trust in Medicare through billing fraud, such as charges for services not used or upgraded services, duplicate claims, identity theft or insurance swapping, illegal kickbacks, impersonating licensed providers, and prescription fraud including forgery, doctor shopping, and drug diversion (FBI, n.d.).

What to do if your doctor or organization appears on the list

First, make sure you are looking at the right list. OpenMedicare is the most comprehensive option, covering about 1.7 million providers in all 50 states and more than 100 specialties. The list is based on CMS’s publicly available Medicare Physician & Other Practitioners dataset, which is released annually and includes billing amounts, service volumes, beneficiary counts, submitted charges, procedure codes, geographic information, and specialty classifications.

If your doctor appears on the list, that does not automatically mean they were or will be charged with fraud. Still, your first move may be to request an itemized record of every service billed under your name and compare it with the visits you actually made, according to OpenMedicare. If you see tests, procedures, or equipment you never received or do not recognize, call 1-800-MEDICARE or use the Medicare fraud hotline. If Medicare already paid fraudulent claims, you may also need to challenge bills sent to collections. Keep an eye on your Medicare Summary Notices and credit reports for claims you did not authorize.

Check whether your doctor has been excluded from Medicare: Use the online search at https://oig.hhs.gov/exclusions/

Look up the doctor on Medicare’s website: Care Compare: https://www.medicare.gov/care-compare/

Get help understanding bills and spotting suspicious claims: Senior Medicare Patrol (free local help): https://www.smpresource.org or 1-877-808-2468. You can also review the Medicare fraud booklet (PDF): https://www.medicare.gov/publications/11610-4rs-for-fighting-medicare-fraud.pdf

Review your claims: Log in to your Medicare account and check claims or Medicare Summary Notices. If you have Medicare Advantage or Part D, you can also call 1-877-772-3379.

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Most Medicare claims are legitimate

Most Medicare claims are valid, and most doctors are honest professionals. Coding errors or missing paperwork are much more common than a doctor trying to steal from Medicare. Questioning a provider can strain the doctor-patient relationship, but ignoring unfamiliar charges can cost both you and the program real money. If you suspect fraud, take the appropriate steps to report it. The goal is to catch problems early, before your finances and your health suffer the consequences.