Where to report Medicare fraud

You can report Medicare fraud to three main places: the Medicare Fraud Hotline, your state's Medicaid Fraud Control Unit, or the Office of Inspector General (OIG). The Medicare Fraud Hotline is the fastest route for most people — you can call 1-800-MEDICARE (1-800-633-4227) and speak to someone directly, or report online at oig.hhs.gov/fraud/hotline.html. The OIG also accepts reports by mail or fax if you prefer not to call.

If the fraud involves a specific Medicare Advantage plan or prescription drug plan, you can also report directly to that plan's compliance department. The plan's customer service number is on your insurance card. State Medicaid Fraud Control Units handle fraud involving both Medicare and Medicaid together, and they investigate cases that cross state lines or involve organized schemes.

You do not need to prove fraud happened — you only need to describe what you saw or experienced. The agencies investigate from there. Reports can be made anonymously, though providing your contact information helps investigators follow up if they have questions.

Key Takeaways

  • Call the Medicare Fraud Hotline at 1-800-MEDICARE to report suspected fraud, or file a report online at oig.hhs.gov/fraud/hotline.html.
  • You can report anonymously, and you do not need proof — describe what happened and let investigators determine whether it is fraud.
  • Keep records of dates, provider names, claim numbers, and what happened; this information helps investigators move faster.
  • Medicare fraud includes billing for services you did not receive, charging more than allowed, billing twice for one service, and upcoding to a more expensive procedure.
  • Reports are confidential, and you cannot be punished for reporting in good faith, even if the investigation finds no fraud.

What counts as Medicare fraud

Medicare fraud is when a provider, supplier, or plan member knowingly bills Medicare for services that were not provided, charges more than the allowed amount, or submits false information to get paid. The most common types are billing for services you never received, billing you twice for one service, upcoding (billing for a more expensive procedure than what was actually done), and billing for unnecessary tests or treatments.

Fraud is different from a billing error. A billing error is a mistake — a provider accidentally codes the wrong procedure or bills the wrong date. Fraud is intentional. If you see a charge on your Medicare statement for a service you know you did not receive, or if a provider pressures you to sign a blank form or tells you not to worry about a copay, those are red flags for fraud.

Abuse is also different from fraud. Abuse means a provider's billing practices are wasteful or unnecessary but not intentionally dishonest — for example, ordering tests that are not medically necessary. You can report abuse the same way you report fraud.

What information to gather before you report

Write down the date or dates when the service happened, the name of the provider or facility, the type of service you received (or believe you should have received), and the claim number if you have it. Your Medicare Summary Notice or Explanation of Benefits statement will have the claim number and the date Medicare processed the claim. If you have a receipt from the provider, keep that too.

Note what made you suspicious — for example, "I received a bill for a doctor visit on a date I was out of state" or "The provider asked me to sign a blank form before the appointment." Write down the names of any staff members you spoke with, if you remember them. If the provider made statements to you about billing or payment, write those down word for word if you can.

You do not need to have all of this information to report. Even if you only remember the provider's name and roughly when it happened, that is enough to start an investigation. Investigators have access to your Medicare records and can pull the details themselves.

How to file a report online or by phone

To report by phone, call 1-800-MEDICARE and tell the representative you want to report fraud. They will transfer you or take your information. The call is free and you can remain anonymous. Have your information written down so you can read it clearly.

To report online, go to oig.hhs.gov/fraud/hotline.html and fill out the form. You can upload documents like receipts or statements. Online reports are also confidential. After you submit, you will receive a confirmation number — save this in case you need to follow up.

You can also mail a report to the Office of Inspector General, U.S. Department of Health and Human Services, 330 Independence Avenue SW, Washington, DC 20201. Include your name and contact information if you are willing to be contacted, or mark the report "anonymous" if you prefer not to be identified. Mail takes longer than phone or online, but it creates a paper record.

What happens after you report

The OIG or your state's Medicaid Fraud Control Unit will review your report and decide whether to investigate. You will not hear back when ready — investigations can take weeks or months. If you provided your contact information, investigators may call you with follow-up questions. You are not required to participate further, but your answers help them build a case.

If the investigation finds fraud, Medicare may recover the money paid out, the provider may face penalties or lose their Medicare billing privileges, and the case may be referred to law enforcement for criminal charges. You will not be told the outcome of the investigation — that information is confidential. But you can check the List of Excluded Individuals and Entities (LEIE) at oig.hhs.gov/exclusions to see if a provider has been excluded from Medicare.

If the investigation finds no fraud, you will not be notified. This does not mean your report was wrong — it means investigators did not find enough evidence to prove intentional fraud. Billing errors or abuse may be addressed without criminal charges.

Your rights and protections when reporting

You are protected by law from retaliation if you report fraud in good faith. This means a provider cannot refuse to treat you, charge you more, or take any negative action against you because you reported them. If a provider retaliates, you can report that retaliation to the OIG as well.

Your report is confidential. The OIG does not release your name to the provider or the public unless you are a witness in a criminal case and are required to testify. Even then, you can ask the court about witness protection options.

You do not need a lawyer to report fraud, and you do not need to pay anyone to help you report. Be cautious of services that charge a fee to "help" you report — reporting is free and you can do it yourself.

Frequently Asked Questions

Can I report fraud if I am not sure it is actually fraud?

Yes. You only need to report what you saw or experienced. Investigators are trained to determine whether it meets the legal definition of fraud. If you are unsure, describe exactly what happened and let them decide. Reports made in good faith are protected even if no fraud is found.

What if I see fraud but I am worried about getting the provider in trouble?

Reporting suspected fraud protects Medicare and other patients. If it turns out to be a billing error, the provider will be asked to correct it. If it is fraud, stopping it prevents it from happening to others. You are not responsible for the outcome — investigators and prosecutors make those decisions.

Do I have to give my name when I report?

No. You can report anonymously by phone, online, or mail. Anonymous reports are investigated the same way, though investigators cannot follow up with you if they have questions. Providing your name does not mean it will be shared with the provider.

How long does an investigation take?

Investigations vary widely depending on the complexity and amount of evidence. Some take a few weeks; others take months or longer. You will not receive updates on the timeline. If you provided contact information, investigators will reach out if they need more details from you.

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

Investigations take time, and a provider is not removed from Medicare when ready after a report. If you see continued suspicious billing, you can report it again with the new dates and details. Each report adds to the pattern investigators are building.