Reporting Medicare Fraud

Medicare fraud is a serious problem, which costs taxpayers millions of dollars. It's important to understand how to report Medicare fraud in order to protect yourself from unscrupulous medical practices. In addition, you may even eligible for a monetary reward of up to $1,000 if you meet certain criteria for reporting a case of Medicare fraud. Through taking a pro-active position to be aware of fraudulent practices, you are protecting yourself, your family, and the country from the proliferation of these practices.

Check your Medicare Summary Notice (MSN)

The first step as you learn how to report Medicare fraud is to determine whether or not you think you are a victim of fraud, or whether your health care provider is committing dishonest actions. The first place to check is your Medicare Summary Notice (MSN), where you can view charges billed to Medicare. The first sign of fraud is unusual charges that you never requested. This could include procedures that were never done, equipment that were never ordered, or drugs you did not need or receive.

When to Call Medicare Claims Department?

Before you call the Medicare claims department, first determine whether these unusual charges are simple errors on the part of your health provider - or perhaps errors on your part. Call your health care provider and inquire about the additional charges. If they promise to rectify the mistakes, pay attention and see whether or not they actually rectify the mistake. If their promises are empty, push them to see why the charges were not corrected. If their promises remain empty, and / or additional charges appear on your next statement that is also erroneous, then it's time to consider the company may be engaging in fraudulent behavior.

Check your Medicare Summary Notice for information about the Medicare supplier that paid the claim. The information on how to report Medicare fraud that you'll need to report can be found at the Medicare.gov fraud and abuse section. This includes: the provider's name, the provider identifying number, the charges you are questioning, the date the charge was created, the amount approved by Medicare, the date of the Medicare Summary Notice, your name and Medicare number (or the name and number of whoever received the service), the reason you believe Medicare should not have paid, and any other information that supports your argument.

How to Report a Medicare Fraud?

You can either write a letter, in which case you should state at the beginning of the letter that you are filing a fraud complaint, or you can call the Office of the Inspector General hotline at 1-800-HHS-TIPS (1-800-447-8477). This number also allows you to make your report anonymously, in case you are self-conscious about publicly making a claim against your health provider. You may also fax this same office at 1-800-223-2164.

Previous methods on how to report Medicare fraud have changed, and new incentives have been established to mitigate the problem. For instance, you may be eligible for a $1000 reward for reporting a case of fraud: however certain conditions must still be met. The fraud must be confirmed as fraud through one of a number of departments affiliated with Medicare, the person or organization you are reporting must not already be under law enforcement investigation, and your report must lead to the collection of at least $100 in defrauded Medicare money.

In addition to the reward possibilities, another incentive to prevent fraud is a star-system recently enacted by the Affordable Care act. You can track the quality standards of different Medicare Advantage companies (HMOs) to help determine what companies you will enroll in. Tracking quality ratings is important in how to report Medicare fraud in the long-run. A company with a low quality rating should generally be avoided. Pay attention to why customers do not like certain companies, and especially if a company has a reputation for any types of ethical violations. You can learn more about the star-system at www.medicare.gov.

What if my Medicare Information have been stolen?

For situations where your Medicare information have been stolen, you should seek an identity theft resource. You can learn more by visiting the Federal Trade Commission website on identity theft at www.ftc.gov/bcp/edu/microsites/idtheft/. You will also need to call the main Medicare hotline and inform a representative of the theft, so that they may cancel any invalid usage of your Medicare information. Just like with any sensitive materials, do not give out your Medicare information, and keep it in a secure place at your home.

Learn how to Report Medicare Fraud


Learning how to report Medicare fraud is not only valuable for the continuation of the Medicare system, but it's also important for protecting your own health and the health of others. Some Medicare scams may involve a health service misdiagnosing a patient with illnesses they do not have, which could actually include costly and unnecessary surgical treatment or being given unnecessary prescriptions. By reporting companies that may be practicing fraudulent services, you are potentially saving victims who the company could someday prey on. For this reason, and many others, you should stay up to date and vigilant against scams in the healthcare industry.