- 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.
Full Answer
How do I report Medicare billing fraud?
Call Medicare to report billing fraud at 1-800-632-4327. If you suspect that a friend or family member—e.g., an aging parent—may have been fraudulently billed, talk with them about the bill.
What to do if you suspect health care fraud?
Report Health Care Fraud We need your help to identify, investigate, and prosecute this crime. If you suspect health care fraud, report it to the FBI at tips.fbi.gov, or contact your health insurance provider. Tips for Avoiding Health Care Fraud
Does the FBI investigate Medicare frauds?
The FBI is responsible for exposing and investigating health care frauds for federal and private insurance programs. As the primary agency, it partners with local, state, and federal agencies to review all cases. It is a collaborative effort since these types of crimes can sometimes be complicated. What is the punishment for Medicare fraud?
Can I remain anonymous during a Medicare fraud investigation?
Medicare won’t use your name during the investigation of Medicare fraud, waste, or abuse; if you don’t want them to, you can remain anonymous. What is Considered Medicare Waste?
How do you address Medicare fraud?
If you suspect Medicare fraud, do any of these: Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
What qualifies as Medicare fraud?
Medicare fraud occurs when someone knowingly deceives Medicare to receive payment when they should not, or to receive higher payment than they should. Committing fraud is illegal and should be reported. Anyone can commit or be involved in fraud, including doctors, other providers, and Medicare beneficiaries.
How do I report someone for medical fraud?
Report it. The Department of Health Care Services (DHCS) asks that anyone suspecting Medi-Cal fraud, waste, or abuse to call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222.
Who enforces Medicare fraud?
Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws.
What factors might be 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.More items...
Is Medi-Cal fraud a felony?
The potential felony prison sentence for most forms of Medi-Cal fraud is anywhere from sixteen (16) months to five (5) years. Felony fines can go up to fifty thousand dollars ($50,000), or double or triple the amount of the fraud.
What happens if I make too much for Medi-Cal?
So, if you're earning enough money to replace the benefits and cover your medical costs without help from the government, then you're usually not eligible for the program. If your expenses are higher than the state average, Social Security may increase the threshold on a case-by-case basis.
What is fraud and abuse in the healthcare industry?
Fraud is the intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. It is estimated that nearly 60 billion dollars are lost annually due to health care fraud and abuse.
Which is an example of Medicare abuse?
One example of Medicare abuse is when a doctor makes a mistake on a billing invoice and inadvertently asks for a non-deserved reimbursement. Medicare waste involves the overutilization of services that results in unnecessary costs to Medicare.
Which is considered Medicare abuse?
What Is Medicare Abuse? Medicare abuse is a form of healthcare fraud that most often involves submitting falsified Medicare claims. Common forms of Medicare abuse include scheduling medically unnecessary services and improper billing of services or equipment.
How to report Medicare fraud?
Reporting Medicare fraud is as simple as making a phone call. If you know Medicare fraud, waste, or abuse that's happening, it’s vital that you report the incident. As citizens, it’s our job to be courageous and prevent injustice from occurring again. Besides, sometimes there is a reward available to the person that reports Medicare fraud, waste, or abuse.
What is the Medicare fraud hotline?
Department of Health and Human Services (HHS) Office of Inspector General (OIG) Medicare fraud hotline at 1-800-HHS-TIPS
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 provider information?
Provider information. Information about the service that was supposedly provided. and the reason you think fraud was committed. If a reported Medicare fraud leads to the recovery of funds, Medicare may provide a reward. If you or someone you know suspects fraud, waste, or abuse, report it immediately.
How long can you be banned from Medicare?
CMS has the ability to block up to 10 years. Second-time offenders can expect up to 20 years’ ban from the Medicare program. CMS hopes these measures will prevent bad actors from stealing tax dollars. In addition to the new rules, CMS is working hard on transparency initiatives.
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 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 fraudulent billing?
Report the fraudulent billing you've experienced, including the name of the medical facility, the supplies, operations, or tests you were incorrectly charged for, and the amount of the charge. Contact ACA Billing at 1-800-318-2596.
Where to report insurance fraud?
In this case, you need to report the fraud to your state's Insurance Fraud Bureau.
How to rectify a medical billing fraud?
Work with a medical billing advocate to rectify the fraud. The advocate will be able to determine whether you have been fraudulently billed and, if you have, they'll follow up with the hospital or with the state medical board. If you're not comfortable accusing the hospital of billing fraud, or if you simply don't have time to pursue the issue, a medical billing advocate may be your best option.
What to do if billing department doesn't have contact information?
If the billing department doesn't have contact information listed, call the office's main number and ask to talk to someone in charge of billing disputes.
What to do if you suspect someone has been fraudulently billed?
If you suspect that a friend or family member—e.g., an aging parent—may have been fraudulently billed, talk with them about the bill. You can also enlist the services of a medical billing advocate on their behalf .
What to do if hospital billing department doesn't correct billing error?
Request the CFO's contact information. If the hospital billing department doesn't correct the billing error, request to contact the Chief Financial Officer. Explain your concern with the billing to the CFO, and ask them what they can do to rectify the situation.
How to dispute a hospital bill?
1. Contact the hospital's billing department. In case the doctor or hospital made an honest mistake, it's best to bring the billing error to their attention as soon as you notice the problem. Look on the office's or hospital's website to find information regarding billing disputes.
Key Takeaways
Medicare fraud can happen when a healthcare provider knowingly bills for services they did not provide or files claims incorrectly to receive a larger reimbursement.
What Is Medicare Fraud?
Medicare fraud happens when someone deceives Medicare to receive undue payment. Healthcare providers who bill for services they did not provide are committing fraud. Providers who bill for more-expensive services than what they actually provided are also committing Medicare fraud.
What Is Medicare Abuse?
Medicare abuse occurs when a healthcare provider orders medically unnecessary tests or services to get larger payments. These extra services increase the number of claims submitted to Medicare and put a strain on the Medicare system.
Spotting Medicare Fraud
A big step in keeping your information safe is knowing how to answer the question, “What is Medicare fraud and abuse ?” Now that you know, it’s time to learn how to spot them when they happen to you. One of the best ways to recognize Medicare fraud is to carefully review your Medicare Summary Notice (MSN).
How Do You Report Medicare Fraud or Abuses?
Are you wondering how to report Medicare fraud? You can report Medicare fraud or suspected fraud in several ways:
Tips for Protecting Yourself From Medicare Fraud and Abuse
Is your provider pressuring you to get services you don’t think you need, or promising that these services are covered? This could be a sign of Medicare fraud or abuse. Be wary of any provider offering additional services, or pushing you to get services that don’t sound medically necessary.
How does fraud affect health insurance?
It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures , and increase taxes. Health care fraud can be committed by medical providers, patients, and others who intentionally deceive ...
How to protect health insurance information?
Protect your health insurance information. Treat it like a credit card. Don't give it to others to use, and be mindful when using it at the doctor’s office or pharmacy. 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 ...
What is bogus marketing?
Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan
Where to take expired pain pills?
If you have unused or expired pain medications, take them to a DEA-approved take back site for disposal.
Is prescription fraud a crime?
Prescription Medication Abuse. Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. But the greatest cost is a human one—tens of thousands of lives are lost to addiction each year.
Which Medicare programs prohibit fraudulent conduct?
In addition to Medicare Part A and Part B, Medicare Part C and Part D and Medicaid programs prohibit the fraudulent conduct addressed by
What is the OIG hotline?
The Office of Inspector General (OIG) Hotline accepts tips and complaints from all sources on potential fraud, waste, and abuse. View instructional videos about the
What is the OIG?
The OIG protects the integrity of HHS’ programs and the health and welfare of program beneficiaries. The OIG operates through a nationwide network of audits, investigations, inspections, evaluations, and other related functions. The Inspector General is authorized to, among other things, exclude individuals and entities who engage in fraud or abuse from participation in all Federal health care programs, and to impose CMPs for certain violations.
What is Medicare abuse?
Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
Why do doctors work for Medicare?
Most physicians try to work ethically, provide high-quality patient medical care, and submit proper claims. Trust is core to the physician-patient relationship. Medicare also places enormous trust in physicians. Medicare and other Federal health care programs rely on physicians’ medical judgment to treat patients with appropriate, medically necessary services, and to submit accurate claims for Medicare-covered health care items and services.
What is heat in Medicare?
The DOJ, OIG, and HHS established HEAT to build and strengthen existing programs combatting Medicare fraud while investing new resources and technology to prevent and detect fraud and abuse . HEAT expanded the DOJ-HHS Medicare Fraud Strike Force, which targets emerging or migrating fraud schemes, including fraud by criminals masquerading as health care providers or suppliers.
What page is OIG?
Office of the Inspector General (OIG) page 19
Where to report a healthcare scam?
If you’re 65 years old and above and using Medicare, you can report suspected fraud to the U.S. Inspector General’s Department of Health and Human Services Office. But if you are using Medicaid, which the state typically funds, you can report the possible abuse to your state’s attorney general’s office or the health and human services department.
When to report fraud?
Since fraud is a severe crime, it’s always prudent to report one after you have tried your best to settle things with the healthcare provider or you’re confident that there are indications of deception. Once you report this crime, you will need to cooperate with authorities and provide proof.
What to do if you see a billing scheme?
If you’re unsure about your findings or don’t know what to do if you see billing schemes, you may seek professional help. To aid in auditing and to understand your billing statement, you may seek the help of an accountant, specifically one who specializes in auditing. They would quickly recognize a case of suspected fraud when they see one, and they could also assist you in gathering proof.
How many hospital bills contain errors?
Hospital billing errors happen all the time. Reports say that almost 80% of hospital medical bills contain mistakes. So, when you find some charge discrepancies, don’t hesitate to call on the hospital billing department to air your concerns.
Can a billing mistake be resolved?
But there may be some instances where your healthcare provider cannot resolve the errors and discrepancies. If you have ongoing therapy, you may also notice recurring errors or patterns of unbundling schemes. Under such circumstances, you may probably have uncovered medical billing fraud, which is a serious felony.
Is it prudent to scrutinize your medical bill?
With the ever-rising cost of healthcare, it’s prudent for everyone to scrutinize their medical bill. It would be best to ascertain that each penny of your hard-earned money that goes into your healthcare bill is accurate. If you find minor mistakes here and there that are accidental errors, they should not be a cause of concern. Medical admin staff can make mistakes, and such instances are more common than you think.
Can you report a hospital bill fraud?
Mistakes in hospital bills happen all the time. It’s best to take time to check your statement and ascertain the items are accurate. However, if you believe you’ve identified a healthcare fraud and the errors in your medical billing are recurring or are part of a blatant scam, you ought to report it immediately. Consult with a lawyer to know your rights and claims as a result of medical billing fraud.
