Where to Report Medicare Fraud

You can report Medicare fraud to three main bodies: Medicare itself, the Department of Health and Human Services Office of Inspector General (HHS OIG), or your state's Medicaid fraud control unit. The fastest route for most people is the Medicare Fraud Hotline, run by HHS OIG. You can call 1-800-MEDICARE (1-800-633-4227) and select the option to report fraud, or visit the online form at oig.hhs.gov. The hotline accepts reports by phone, mail, or online submission.

If you suspect fraud by a specific provider — a doctor, hospital, nursing home, or durable medical equipment supplier — you can also report directly to your Medicare Advantage plan or Original Medicare carrier. Your insurance card lists the plan name and phone number. State Medicaid fraud control units handle fraud involving both Medicare and Medicaid; you can find your state's unit through the National Association of Medicaid Fraud Control Units website.

Reports can be made anonymously. You do not need to provide your name, and you do not need to be the person harmed by the fraud. If you witnessed billing fraud at a provider you use, or you are a healthcare worker who saw it happen, you can report it without identifying yourself.

Key Takeaways

  • The HHS OIG Medicare Fraud Hotline at 1-800-MEDICARE accepts reports by phone, mail, or online and is the primary route for most fraud reports.
  • You can report fraud anonymously and do not need to be the person directly harmed; witnessing fraud at a provider is enough to report it.
  • Common fraud signs include bills for services you did not receive, duplicate charges, charges for items you returned, or providers billing for higher-cost items than what was actually provided.
  • Gather specific details before reporting: the provider's name and address, the dates of service, your Medicare claim number, and what happened.
  • After you report, HHS OIG may investigate, but you will not receive updates on the outcome unless you are a witness called to testify.

What Counts as Medicare Fraud

Medicare fraud is intentional deception by a provider or supplier to get paid for services or items that were not provided, were not medically necessary, or were billed at a higher cost than what was actually delivered. The key word is intentional — a billing error made by accident is not fraud, though it should still be corrected.

Common fraud schemes include billing for services you never received, billing for a more expensive service than what you actually got, submitting duplicate claims for the same visit or procedure, billing for items you returned or never picked up, and upcoding — charging for a higher-level service code to increase payment. A provider might also bill Medicare for a service and then bill you separately, or bill for unnecessary tests or treatments you did not consent to.

Fraud is different from abuse, which is billing that violates Medicare rules but may not involve intentional deception — for example, billing for a service that was not medically necessary, even if the provider believed it was. Both fraud and abuse should be reported, but fraud investigations are criminal and may involve law enforcement.

How to Gather Information Before You Report

Before you call or submit a report, collect the specific details about what happened. Start with your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) — the statements Medicare sends you after each claim is processed. These show what was billed, what Medicare paid, and what you owe. Highlight the charges that seem wrong and note the dates of service, the provider name, and the claim number.

Write down the provider's full name, address, and phone number. If you have it, include their National Provider Identifier (NPI), a 10-digit number that appears on bills and statements. Note the specific dates when you received (or did not receive) the service, what the service was supposed to be, and what actually happened. If you have the original bill or receipt, keep it.

If you are reporting fraud you witnessed as a healthcare worker — for example, you saw a nurse bill for a procedure that was not performed — write down the date, time, who was involved, and exactly what you observed. The more specific you are, the easier it is for investigators to follow up.

How to Submit Your Report

To report by phone, call the Medicare Fraud Hotline at 1-800-MEDICARE and follow the prompts to report fraud. Have your information ready: the provider's name and address, the dates of service, your Medicare claim number, and a brief description of what happened. The call usually takes 10 to 15 minutes. You will receive a reference number; write it down in case you need to follow up.

To report online, visit oig.hhs.gov/fraud and complete the online complaint form. You can attach documents like copies of bills or statements. Online reports are processed the same way as phone reports and may be faster if you prefer not to call.

To report by mail, send a written statement to the HHS Office of Inspector General, Attn: Complaint Intake, 330 Independence Avenue SW, Cohen Building, Room 5541, Washington, DC 20201. Include your name and contact information (if you choose to provide it), the provider's name and address, dates of service, your claim number, and a clear description of the fraud. Mail reports take longer to process but create a paper record.

What Happens After You Report

After you submit a report, HHS OIG reviews it to decide whether to investigate. Not every report leads to an investigation — the agency prioritizes cases involving large dollar amounts, patterns of fraud across multiple patients, or providers with a history of violations. If your report is one of many against the same provider, it strengthens the case.

If an investigation is opened, you will not receive regular updates. The OIG does not notify reporters of outcomes unless you are called as a witness or the case goes to trial. Investigations can take months or years. If fraud is confirmed, the provider may be required to repay Medicare, face civil penalties, lose their Medicare billing privileges, or be prosecuted criminally.

If you reported fraud that affected your own bill, you can also contact your Medicare Advantage plan or Original Medicare carrier separately to ask them to review the charges. You have the right to dispute any charge on your statement within the timeframe listed on your EOB or MSN.

Protecting Yourself from Fraud

Review your Medicare Summary Notice and Explanation of Benefits every month. Look for charges you do not recognize, services you did not receive, or duplicate billings. If you see something wrong, contact your provider first to ask for an explanation — sometimes it is a clerical error. If the provider cannot explain it or refuses to correct it, report it.

Keep copies of receipts, bills, and records of services you receive. If a provider bills you for something you returned or did not pick up, keep the proof — a receipt showing the return, an email confirming cancellation, or a dated note of the conversation.

Be cautious about providers who offer free items or services in exchange for your Medicare number, bill you for items you did not order, or pressure you to receive unnecessary services. These are common fraud warning signs. You can always ask a provider why a service is medically necessary before you consent to it.

Frequently Asked Questions

Do I have to give my name when I report fraud?

No. You can report fraud anonymously by phone, mail, or online. However, if you provide your name and contact information, investigators may reach out if they need more details or want you to testify. Providing your information does not put you at legal risk — federal law protects people who report fraud in good faith.

What if I am not sure if it is fraud or just a billing mistake?

Report it anyway. The HHS OIG can tell the difference between fraud and error. If it turns out to be a mistake, no harm is done. If it is fraud, your report helps stop it. When in doubt, err on the side of reporting.

Can I report fraud if I am a Medicare provider or employee?

Yes. Healthcare workers and providers can report fraud they witness. You can report anonymously, and federal law protects whistleblowers from retaliation. If you work for a provider and see fraud, you can also contact your state's Medicaid fraud control unit or consult an employment lawyer about your rights.

How long does it take to investigate a fraud report?

Investigations vary widely — some take a few months, others take a year or more. The complexity of the case, the amount of money involved, and the agency's workload all affect timing. You will not receive updates unless you are asked to participate as a witness.

What if the provider is still billing Medicare after I reported them?

Report it again. Multiple reports from different people strengthen the case and may move it up the priority list. You can also contact your Medicare Advantage plan or Original Medicare carrier to ask them to review the provider's billing patterns.