Medicare Fraud

The Centers for Medicare and Medicaid Services (“CMS”) is the agency within the Department of Health and Human Services that oversees the Medicare and Medicaid Programs. For more information about CMS, please click on the following link: http://www.cms.hhs.gov.

How to Report Medicare Fraud

You, as the Medicare beneficiary, are the most important link in finding Medicare fraud. You know better than anyone what healthcare services you have received. Review your Medicare Summary Notice when you receive it, and make sure you understand all of the items listed.

If you don’t remember a procedure that is listed, you should first call your physician, provider, or supplier that is listed on the Medicare Summary Notice. Many times a simple mistake has been made and can be corrected by your physician, provider, or supplier’s office when you call.

If your physician, provider, or supplier’s office does not help you with the questions or concerns about items listed on your Medicare Summary Notice and you still suspect Medicare fraud or if you cannot call them, you should call or write the Medicare company that paid the claim. The name, address, and telephone number are on the Medicare Summary Notice (MSN) you receive, which shows what Medicare paid.

Before contacting the Medicare claims processing company, carefully review the facts as you know them and as shown on the Medicare Summary Notice. Write down:

The provider's name and any identifying number you may have.
The item or service you are questioning.
The date on which the item or service was supposedly furnished.
The amount approved and paid by Medicare.
The date of the Medicare Summary Notice.
The name and Medicare number of the person who supposedly received the item or service.
The reason you believe Medicare should not have paid.
Any other information you may have showing that the claim for the item or service should not have been paid by Medicare.

If you plan to write rather than call, clearly state at the beginning of your letter that you are filing a fraud complaint. This will help to ensure that your complaint is forwarded to the fraud unit.

Office of Inspector General Hotline

The Office of Inspector General for the U.S. Department of Health and Human Services is responsible for the investigation of healthcare fraud, particularly Medicare and Medicaid fraud. For more information about the Office of Inspector General, please click on the following link: http://oig.hhs.gov.

To further assist you, the Office of Inspector General maintains a hotline, which offers a confidential means for reporting vital information related to potential Medicare fraud. The Hotline can be contacted in the following ways:

	By Phone:	1-800-HHS-TIPS (1-800-447-8477)
	By Fax:	1-800-223-2164 (no more than 10 pages please)
	By E-Mail:	HHSTips@oig.hhs.gov
	By Mail:	Office of Inspector General U.S. Department of Health and Human Services HHS TIPS Hotline P.O. Box 23489 Washington, DC 20026

If you are attempting to report specific information proving Medicare fraud, please provide as much identifying information as possible regarding your concern. Such information should include subject's name, address and phone number etc. Details regarding the allegation should include the basics of who, what, when, where, why, and how.

Please note that it is current Hotline policy not to respond directly to written communications.

OFFICE INFORMATION

Other DHHS Units

Medicare Fraud

How to Report Medicare Fraud