- 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.
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. ...
What is a complaint?
What is the difference between a complaint and an appeal?
Can you file a complaint with Medicare?
About this website
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.
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. Medicare fraud costs Medicare a lot of money each year. See: Examples of possible Medicare fraud.
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. A lock ( A locked padlock ) or https:// means you've safely connected to the .
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.
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.
How do I report to CMS?
How to File a Complaint.CMS, on behalf of HHS, enforces HIPAA Administrative Simplification requirements.Go to ASETT.CMS.GOV.Upon logging in, click the "New Complaint" button on the welcome page.Click “Complaint Type” and select the issue you are reporting.More items...
What is a major part of Medicare fraud?
Billing for physician visits and services not rendered or not medically necessary. Billing for durable medical equipment such as wheelchairs, body jackets, incontinence supplies or diabetic supplies without a doctor's prescription.
Which entity investigates suspected cases of fraud?
The Office of the Inspector General (OIG) is tasked to investigate suspected healthcare fraud activities and report cases to the U.S. Department of Justice (DOJ) for criminal or civil actions. They are also tasked to seek civil monetary penalties and assess if such Stark Violations are part of the exceptions.
Why is Medicare fraud an issue?
There are health care consequences due to Medicare fraud. A beneficiary may later receive improper medical treatment from legitimate providers because of inaccurate medical records that may contain false diagnoses or incorrect lab results.
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.
Whats a red flag in a bank account?
Key money laundering red flags observed by AUSTRAC include: Frequent large cash deposits or withdrawals. Large fund transfers from business to personal accounts. High volume international fund transfers.
Filing complaints about a doctor, hospital, or provider | 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:. Medicare; Your Medicare health plan; Your Medicare drug plan
How can I complain about poor medical care I received in a hospital?
While you are in the hospital: If possible, first bring your complaints to your doctor and nurses.Be as specific as you can and ask how your complaint can be resolved. You can also ask to speak to a hospital social worker who can help solve problems and identify resources.
Notices and Forms | CMS
The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Grievances | CMS
A grievance is any complaint or dispute (other than an organization determination) expressing dissatisfaction with any aspect of the operations, activities, or behavior of a Medicare health plan, or its providers, regardless of whether remedial action is requested.
Contact Medicare | Medicare
Phone 1-800-MEDICARE (1-800-633-4227) For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.. If you want Medicare to be able to give your personal information to someone other than you, you need to fill out an "Authorization to Disclose Personal Health Information."
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.
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.
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.
What happens if a doctor finds a loophole?
When your doctor or healthcare worker finds loopholes to receive payment when they normally wouldn’t, they commit fraud. If a doctor ever says one of these things to you, report it immediately:
Who investigates Medicare fraud?
Contact the nearest SMP program. The Senior Medicare Patrol investigates fraud and can assist you in filing your report as well as answering any questions you have.
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 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.
How to report Medicare fraud to the OIG?
You can call the national fraud hotline at 1-800-MEDICARE to report fraud to the OIG.
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 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.
How long does it take to file a complaint with Medicare?
To file a complaint about your Medicare prescription drug plan: You must file it within 60 days from the date of the event that led to the complaint. You can file it with the plan over the phone or in writing. You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
What are some examples of complaints about a drug plan?
Complaints about your health or drug plan could include: Customer service: For example, you think the customer service hours for your plan should be different. Access to specialists: For example, you don't think there are enough specialists in the plan to meet your needs.
How long do you have to notify a health insurance company of a decision?
You must be notified of the decision generally no later than 30 days after the plan gets the complaint.
What is a drug error?
Drug errors: Like being given the wrong drug or being given drugs that interact in a negative way.
Phone
For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.
1-800-MEDICARE (1-800-633-4227)
For specific billing questions and questions about your claims, medical records, or expenses, log into your secure Medicare account, or call us at 1-800-MEDICARE.
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.