How Do I Report Original Medicare Fraud?

Steven Mott by Steven Mott | Licensed since 2012

This article was updated on: 09/16/2018

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The Centers for Medicare & Medicaid Services (CMS) reports that Medicare fraud and abuse can cost taxpayers billions of dollars and put the health of Medicare beneficiaries at risk.

What is Medicare fraud?

According to CMS, there are different types of Medicare fraud. Here are just a few examples:

  • When a doctor or provider knowingly sends Medicare a bill for health services or supplies that were never provided
  • When a provider pays for referrals of Medicare beneficiaries
  • When a hospital bills Medicare for services that cost more than the actual services provided

How can I spot Medicare fraud?

If you have Original Medicare (Part A and Part B), you should compare your Medicare Summary Notice (MSN) with statements and receipts from your health-care providers. This is a notice of all the services and supplies that were billed to Medicare over a three-month period. If you don’t recognize a particular item or provider, you can start by contacting the doctor’s office to double check to see if a billing mistake was made – which could count as Medicare fraud.

Is there a Medicare fraud phone number or hotline?

If you think there may be a case of Medicare fraud, you can call the Medicare fraud hotline or report the fraud in several other ways:

  • Calling the Department of Health and Human Services (HHS) Office of Inspector General (OIG) Medicare fraud hotline at 1-800-HHS-TIPS (1-800-447-8477). Phone lines are open 24 hours a day, 7 days a week.
  • Calling the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227). Phone lines are open 24 hours a day, 7 days a week.
  • Contacting CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044.
  • Reporting the fraud to the HHS online at Hotline Operations.
  • Contacting the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-3489.

When reporting Medicare fraud, it’s helpful to have the following information on hand:

  • Your Medicare number
  • Information about the provider
  • Information about the service that was supposedly provided, such as the date of service and payment amount approved and paid by Medicare
  • The reason you think fraud was committed

If reported Medicare fraud leads to recovery of Medicare funds, Medicare may provide incentive rewards when certain conditions are met.

If you’re interested in learning more about Medicare, just let me know. If you’d like to speak by phone or get an email with customized Medicare plan options, there are links to do that below, too. To search for plans now, use the Compare Plans or Find Plans buttons on this page.

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