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
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 here: The Office of the Inspector General
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) < http://www.medicare.gov/Basics/SummaryNotice.asp> 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 < 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 < mailto:HHSTips@oig.hhs.gov%20>
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.
