When was the last time you checked whether every laboratory test appearing on your Medicare claims was one you actually received? That question suddenly carries more weight after the Centers for Medicare & Medicaid Services announced that enforcement actions have stopped more than $1.6 billion in potentially improper Medicare laboratory payments. CMS says its crackdown has included $732 million in savings from revoking 157 fraudulent laboratory providers, more than $500 million halted through payment suspensions, and another $276 million recouped from identified overpayments. The agency has specifically targeted labs suspected of billing for tests that weren’t performed, medically unnecessary services, and more expensive services than those actually provided. Here are seven things you may want to take a closer look at.
1. Start With Tests You Don’t Remember Having
A legitimate laboratory claim won’t necessarily have a name you recognize because the laboratory processing your sample may be different from your doctor’s office. Still, you should generally be able to connect a claim with an appointment, blood draw, specimen collection, or test your health-care provider ordered. CMS says its recent enforcement efforts identified laboratories suspected of billing Medicare for services that weren’t actually rendered. One Texas lab that began billing in February 2026 had $1.2 million in claims denied before CMS says the company altered its billing practices, after which additional suspect payments were stopped. During your Medicare claims review, an unfamiliar test should therefore prompt a question rather than an automatic assumption that it must be correct.
2. Pay Attention to Genetic and Specialized Tests
Some laboratory descriptions can be intimidating enough that it’s tempting to skip over them, particularly when they involve unfamiliar genetic or high-complexity testing. The risk isn’t theoretical. In February 2026, a federal jury convicted a Texas laboratory owner in a $328 million cardiovascular genetic-testing fraud scheme that prosecutors said involved medically unnecessary tests, telemarketing, beneficiary DNA samples, Medicare numbers, and kickbacks for referrals.
CMS says the fraud patterns it is targeting can occur across genetic testing, pathogen detection, and high-complexity drug testing. That doesn’t mean those tests are inherently suspicious, because they can be medically appropriate and legitimately covered in the right circumstances. The concern is a claim for specialized testing you never discussed with your doctor, particularly when you don’t remember providing the blood, saliva, urine, or other sample needed to perform it.
The amount Medicare spends on laboratory testing helps explain why this area attracts so much scrutiny. The HHS Office of Inspector General reported that Medicare Part B spent $8.4 billion on clinical diagnostic laboratory tests in 2024, with genetic tests alone accounting for more than $3.6 billion, or 43% of total lab spending. Spending on genetic tests has also been climbing even as Medicare spending on many traditional non-genetic tests has declined. That doesn’t make an expensive or unfamiliar genetic test fraudulent, but it helps explain why federal investigators are paying particular attention to this rapidly growing category.
If you’re unsure, call the physician who supposedly ordered the test and ask whether the office has a record of ordering it for you.
3. Check Whether You Recognize the Ordering Provider
Sometimes the laboratory itself isn’t the biggest clue. The doctor supposedly connected to the test is. CMS says its recent enforcement has targeted medically unnecessary laboratory services billed for beneficiaries who had no established relationship with the ordering provider. Imagine finding a sophisticated laboratory test ordered by a physician in another state whose name you’ve never heard and whom you’ve never seen, either in person or through telehealth. That doesn’t prove fraud by itself because legitimate medical arrangements can involve providers patients don’t directly meet, but it deserves an explanation. A careful Medicare claims review should therefore include the provider names and dates, not merely the dollar amounts Medicare paid.
4. Don’t Assume Medicare Paid Every Claim You See
Your Medicare Summary Notice can contain more information than simply a list of bills you owe. Medicare explains that the MSN shows Part A and Part B services or supplies providers billed to Medicare, what Medicare paid, and the maximum amount you may owe. The government specifically recommends keeping receipts and bills and comparing them with your MSN to confirm that you actually received all services, equipment, and supplies shown there. If you find a claim you don’t understand, checking whether Medicare approved, denied, or adjusted it can help you understand what happened before calling the provider. The statement is not itself a bill, so don’t send money merely because an unfamiliar service appears on it.
5. Your Memory Can Catch Something an Algorithm Can’t
CMS says it now uses advanced analytics, including artificial intelligence and machine-learning models, to search Medicare fee-for-service claims for unusual billing behavior. Those systems can analyze patterns involving testing, documentation, results, billing practices, and provider relationships and flag high-risk claims for further review. That’s powerful fraud detection, but CMS’s computers don’t share your firsthand memory of where you were last Tuesday or whether anyone actually drew your blood. You may instantly know that a claim looks impossible because you haven’t had laboratory work in six months, while an automated system has to infer suspicious behavior from broader data. Keeping a simple calendar of appointments and tests can make your own Medicare claims review substantially easier.
6. You Don’t Have to Wait for a Paper Statement
Original Medicare beneficiaries can review claims through their secure Medicare account rather than waiting for the next Medicare Summary Notice to arrive. Medicare says processed Part A and Part B claims are usually visible in the account within 24 hours after Medicare processes them. Beneficiaries can also choose electronic Medicare Summary Notices, which provide an email link for any month in which a claim is processed rather than waiting for a paper MSN. Medicare specifically promotes electronic statements as a way to track claims and costs, catch billing errors, and help prevent fraud by verifying that you’re billed only for services you actually received. Medicare Advantage members should instead review their plan’s Explanation of Benefits and contact the plan for current claims information.
7. An Unfamiliar Claim Could Point to a Bigger Problem
A questionable laboratory claim doesn’t automatically mean someone stole your Medicare information, because billing mistakes and confusing provider names do happen. However, Medicare warns that medical identity theft occurs when someone uses another person’s information without consent to commit Medicare fraud or other crimes. That’s why beneficiaries should protect their Medicare number much like other valuable personal information and avoid providing it to unsolicited callers offering supposedly free tests or medical services. If you recognize the provider but think the charge is incorrect, Medicare suggests contacting the provider’s office first because staff may be able to explain the service or correct an error.
There can also be a direct financial reason to question an unfamiliar test rather than assuming it’s only Medicare’s problem. The HHS Office of Inspector General warns that beneficiaries who accept genetic testing that wasn’t properly ordered or medically necessary could potentially be responsible for the entire cost if Medicare denies the claim, and some tests can cost thousands of dollars. That’s another reason to be skeptical of callers, health-fair representatives, or marketers offering supposedly “free” genetic testing in exchange for a Medicare number. A test advertised as costing you nothing isn’t necessarily harmless if it was never legitimately ordered in the first place.
If you still suspect fraud, Medicare says you can report it through 1-800-MEDICARE (1-800-633-4227) or its online fraud-reporting system.
A Five-Minute Medicare Claims Check
When you review your Medicare claims, don’t try to decipher every medical code before looking for the basics. First, check the date and ask whether you received medical care that day; next, look at the provider or laboratory and determine whether you recognize it; then review the test or service and whether you remember your doctor ordering it. Compare those details with your calendar, receipts, patient portal, or other records before assuming an unfamiliar claim is fraudulent. If something still doesn’t make sense, call a provider you recognize for clarification or contact Medicare rather than ignoring the entry.
A Five-Minute Review Can Give Medicare Something Technology Can’t
CMS’s new laboratory crackdown demonstrates why a Medicare claims review shouldn’t be treated as paperwork you automatically file away. The agency says 157 fraudulent providers have been revoked and hundreds of millions of dollars in additional potentially improper payments have been suspended, recouped, or prevented through referrals and other enforcement efforts. Even with increasingly sophisticated fraud-detection technology, beneficiaries remain uniquely positioned to recognize a simple but critical fact: “I never received that test.” Compare your claims with your calendar, investigate providers and services you don’t recognize, and report genuinely suspicious activity instead of assuming Medicare has already caught everything.
Have you ever checked your Medicare statement and discovered a test, provider, or service you couldn’t explain? Share what you found in the comments.
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