- Department of Health and Human Services (HHS) Office of Inspector General (OIG) Medicare fraud hotline at 1-800-HHS-TIPS
- Contact the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-348
- Centers for Medicare and Medicaid Services at 1-800-MEDICARE
- Contact CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044
- You can report it by calling the CMS report hotline or submit the information online.
- Call Medicare's help line at 800-633-4227.
- Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950).
- File an online report with the Office of Inspector General.
What do you need to know about Medicare fraud?
“Medicare fraud” is actually a blanket term encompassing different fraudulent activities related to the Medicare system. What is perhaps most staggering is the amount of money alleged to be falsely billed by this collection of once-trusted medical professionals and agencies. The total? Somewhere around $1.3 billion.
How to report Medicare fraud?
- Call Medicare’s help line at 800-633-4227.
- Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950).
- File an online report with the Office of Inspector General.
How do I report fraud, waste or abuse of Medicare?
You can report suspected fraud or corruption by:
- completing our reporting suspect fraud form
- completing our health provider fraud tip-off form
- calling our fraud hotline – 1800 829 403
- writing to us
How do you report medical fraud?
Tips for Avoiding Health Care Fraud
- Protect your health insurance information. Treat it like a credit card. ...
- Beware of “free” services. If you're asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged to your ...
- Check your explanation of benefits (EOB) regularly. ...
How do I deal with Medicare fraud?
If your question is not resolved and you still think the charges are fraudulent, call our California Senior Medicare Patrol: 1-855-613-7080. You can also contact the U.S. Department of Health and Human Services' Office of Inspector General: 1-800-447-8477.
How do I report potential Medicare fraud?
To report suspected Medicare fraud, call toll free 1-800-HHS-TIPS (1-800-447-8477). Medicare fraud happens when Medicare is billed for services or supplies you never got.
Who is in charge of Medicare fraud?
Medicare Fraud Strike Force | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services. A . gov website belongs to an official government organization in the United States.
What are red flags for Medicare fraud?
Some red flags to watch out for include providers that: Offer services “for free” in exchange for your Medicare card number or offer “free” consultations for Medicare patients. Pressure you into buying higher-priced services. Charge Medicare for services or equipment you have not received or aren't entitled to.
What is a Medicare ombudsman?
The Medicare Beneficiary Ombudsman helps you with complaints, grievances, and information requests about Medicare. They make sure information is available to help you: Make health care decisions that are right for you. Understand your Medicare rights and protections. Get your Medicare issues resolved.
How are Medicare whistleblower rewards paid?
How are Medicaid and Medicare whistleblower rewards paid? Qui tam relators (whistleblowers) are paid directly by the government from the recoveries obtained from successful False Claims Act lawsuits.
What is a major part of Medicare fraud?
Misusing codes on a claim, such as upcoding or unbundling codes. Upcoding is when a provider assigns an inaccurate billing code to a medical procedure or treatment to increase reimbursement. Medicare abuse can also expose providers to criminal and civil liability.
Which is the most common form of health care fraud and abuse?
Fraudulent provider billing, duplicate billing, and billing for services not medically needed accounted for 46 percent of provider fraud cases in 2016. Billing for services not performed is the most common provider fraud activity and defrauds millions from public and commercial insurers alike.
What is account take over fraud?
Account takeover fraud is a form of identity theft. It works through a series of small steps: A fraudster gains access to victims' accounts. Then, makes non-monetary changes to account details such as: Modifies personally identifiable information (PII)
What happens when a bank red flags your account?
A red flag on your account can trigger a freeze, but if you can show your transactions are legal it can usually be cleared up. Some banks won't take a chance — they might just close your account at the first whiff of trouble.
How do banks know red flags?
Unusual or suspicious account activityNonpayment when there is no history of late or missed payments.Material increase in the use of available credit.Material change in spending patterns.Material change in electronic fund transfer patterns.
What is a complaint?
File a complaint (grievance) Filing complaints about a doctor, hospital, or provider. Filing complaints about your health or drug plan. Filing a complaint about your quality of care. Complaints about your dialysis or kidney transplant care.
What is the difference between a complaint and an appeal?
What's the difference between a complaint and an appeal? A complaint is about the quality of care you got or are getting. For example, you can file a complaint if you have a problem calling the plan, or you're unhappy with how a staff person at the plan treated you. You file an appeal if you have an issue with a plan's refusal to cover a service, ...
Can you file a complaint with Medicare?
You can file a complaint if you have concerns about the quality of care or other services you get from a Medicare provider. How you file a complaint depends on what your complaint is about.
What is Medicare fraud?
The Center for Medicare and Medicaid Services (CMS) states that Medicare fraud is: Intentionally billing Medicare for a service not provided. Billing Medicare at a higher rate. If a provider pays for referrals of Medicare beneficiaries.
What to do if you think there is an error in Medicare?
If you think the error is intentional or the doctor admits to an error, you’ll need to report it. An error, intentionally or unintentionally, is Medicare waste.
How to contact HHS?
Contact the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-348. Centers for Medicare and Medicaid Services at 1-800-MEDICARE. Contact CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044. You can report it by calling the CMS report hotline or submit the information online.
What is the difference between fraud and waste?
Differences between Medicare Fraud, Abuse, and Waste. Fraud requires intent to obtain payment and knowing the action is wrong. Abuse creates an unnecessary cost to the Medicare Program, without knowledge. Waste may involve intent or knowledge but could also be unintentional.
What happens if a provider doesn't follow proper medical practices?
When a provider doesn’t follow proper medical practices and unnecessary tests, they are committing Medicare Abuse. Practices that result in unnecessary costs to Medicare are considered abusing the system. Medicare abuse is a serious crime, and violators will be prosecuted.
What is Medicare program integrity enhancement?
Medicare creates the Program Integrity Enhancements to the Provider Enrollment Process rule to end fraud, waste, and abuse. Basically, Medicare expects providers and suppliers to meet specific standards to remain in the Medicare program.
How long can you go to jail for health care fraud?
Health care fraud is a federal crime with serious consequences. If convicted you could serve up to 10 years in federal prison and pay hefty fines of up to $250,000. If you cause serious bodily harm/injury to someone, 20 years could be added to your sentence. However, if death is involved, you could face life in prison.
How to report Medicare fraud?
If you suspect a fraud has occurred, you should report it, providing as many details as you can, in any of the following ways: 1 Call Medicare’s help line at 800-633-4227. 2 Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950). 3 File an online report with the Office of Inspector General.
How to contact Medicare for a report?
Call Medicare’s help line at 800-633-4227. Call the Office of Inspector General directly at 800‑HHS‑TIPS (800‑447‑8477, or TTY 800‑377‑4950). File an online report with the Office of Inspector General.
Who investigates Medicare cases?
The Office of Inspector General of Medicare investigates and prosecutes many such cases, some of which are brought to light by Medicare beneficiaries who notice something that doesn’t look right and report it.
Do you have to identify yourself when reporting a suspected fraud?
You are not required to identify yourself when reporting a suspected fraud, although keep in mind that the investigators may want to contact you for further information in order to pursue the case properly. If your suspicion is confirmed and leads directly to the recovery of Medicare money, you may get up to $1,000 as a reward.
What is Medicare fraud?
In the Medicare context, fraud scheme include billing Medicare for services that were not delivered, or increasing the payment amount on claims forms. Health care providers who intentionally bill false charges to Medicare cost taxpayers billions of dollars a year and put the health of Medicare beneficiaries at risk.
What is the number to report Medicare fraud?
You can call the national fraud hotline at 1-800-MEDICARE to report fraud to the OIG.
What are some examples of Medicare fraud?
Examples of medicare abuse or fraud include suppliers billing Medicare for equipment you never ordered or received, or healthcare providers billing Medicare for services you were never provided. Fraud ranges from broad-based operations by nationwide institutions to individual health care providers working on a small scale.
What to do if you find a discrepancy in Medicare?
Call your doctor. If you find a discrepancy, call your doctor before you report fraud to make sure the questionable charges weren't made in error.
What to do if you suspect fraud or abuse?
If you suspect fraud or abuse, study the entries on your claim forms and compare them to earlier records. When you visit your doctor or order medical supplies, record the dates yourself along with the services or supplies you will receive.
Where to report fraud to HHS?
You also can report fraud by sending a written account through the mail to the HHS Office of the Inspector General at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-3489 or to the Centers for Medicare and Medicaid Services at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044.
What is abuse in healthcare?
Abuse includes acts such as over-charging for services, or unbundling services, which happens when a health care provider charges separately for individual components of one service rather than the single charge for the service as a whole. Bending the rules constitutes abuse, whereas intentional deception may be fraud.
How to file an appeal with Medicare?
For questions about a specific service you got, look at your Medicare Summary Notice (MSN) or log into your secure Medicare account . You can file an appeal if you disagree with a coverage or payment decision made by one of these: 1 Medicare 2 Your Medicare health plan 3 Your Medicare drug plan
What is an improper care complaint?
Improper care or unsafe conditions. You may have a complaint about improper care (like claims of abuse to a nursing home resident) or unsafe conditions (like water damage or fire safety concerns).
What You Need to Know
HHS-OIG’s Hotline reviews and investigates thousands of complaints each year. We recommend you review Before You Submit a Complaint to understand the type of complaints we do and do not investigate and the complaint process.
How to Contact the OIG Hotline
Start your online complaint with HHS-OIG by selecting an option below. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS programs and from HHS employees, grantees and contractors who are reporting wrongdoing at HHS and its programs (whistleblowers) for the first time.
Línea Directa de Comunicación del OIG – Sección de Operaciones
Contactar la línea directa de comunicación del OIG es tan fácil. La línea directa de comunicación del OIG acepta la información y quejas de todas las fuentes sobre la posibilidad de fraude, despilfarro, abuso ó mala administración dentro de los programas del Departamento Estadounidense de Salud & Servicios Humanos (U.S.
