Tuesday, May 14, 2024

How Do I Report Medicare Fraud

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Physical Abuse Of A Patient

Reporting Fraud to OIG

When any provider or employee of a Medicaid-funded facility physically assaults any resident, MID can investigate. We investigate abuse whether or not it leads to serious injury, and even if the patient is not a Medicaid recipient. We also investigate physical abuse of Medicaid patients by caregivers in settings other than nursing homes.

What Can You Do To Help Prevent Report And Stop Fraud Waste And Abuse

Report potential fraud:

  • Fraud and Abuse Hotline: 1-866-685-8664
  • Arizona Complete Health Attn: Compliance Officer1870 W. Rio Salado Parkway Tempe, AZ 85281
  • Mail: Office of Inspector General 801 E. Jefferson St.,
  • Outside of Maricopa County: 888-ITS-NOT-OK or 1-888-487-6686
  • To Report Member Fraud:
  • Website:
  • In addition to notifying the regulators above, providers must immediately notify Arizona Complete Health of all suspected fraud, waste, and/or program abuse. Arizona Complete Health providers must report suspected fraud, waste, and program abuse directly to the health plan immediately upon identification and notification to their regulator.

    To protect the public from consumer fraud.

    If you believe you have been the victim of consumer fraud, you may file a consumer complaint with the Arizona Attorney General’s Office. For consumer inquiries, or to request a complaint form, call 542-5763 , 628-6648 , or toll-free outside of metro Phoenix, 352-8431.

    Report Medicare Fraud And Abuse

    If you suspect Medicare fraud or abuse, you should report it right away. The Centers for Medicare & Medicaid Services , which administers Medicare, is cracking down on this type of activity. The agency is working with beneficiaries, doctors, and federal agencies â such as the Department of Health and Human Services , the Office of Inspector General, the Federal Bureau of Investigations , and the Department of Justice â to detect and prosecute those who commit Medicare abuse and Medicare billing fraud.

    To report Medicare fraud or abuse, you can do any of the following:

    • Fax your report to 1-800-223-8164.
    • Mail the report to Office of the Inspector General HHS Tips Hotline, P.O. Box 23489, Washington, DC 20026-3489.

    Please note that the contact information above is only to be used for reporting fraud or abuse.

    Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

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    Suspected Fraud Against Activities Funded By The Department Of Health And Aged Care

    Activities funded by the Department of Health and Aged Care may include:

    • aged care services

    The Department also funds activities through grants and other payments.

    Fraud against these activities may include:

    • providing misleading information to receive a grant or payment
    • using Health and Aged Care funding for different purposes than it was meant for

    Anyone can report suspected fraud against activities funded by the Department of Health and Aged Care. Any information that you can provide is valuable.

    National Report Medicare Fraud Day Official Website

    The Best Way to Protect Your Money from Medicare Fraud
    The official National Report Medicare Fraud Day is September 12. This website also show you how to report all types of Medicare fraud, ranging from Home Health Care Fraud, Kickback Fraud, Long Term Acute Care Hospital Fraud, Medicare Advantage Fraud, Stark Violations Fraud, and Upcoding Fraud. Each of these types of Medicare fraud has their own National Day too! Explore this website and find out how to detect and then report Medicare fraud.

    Ten percent of all Medicare funds are lost due to fraud. Because the government spends $650 billion a year on Medicare $65 billion a year is lost to Medicare fraud. Its no wonder why we have a national health care crisis!

    The money stolen by those cheating Medicare comes out of your pocket, as a faithful citizen and taxpayer. Worse yet, for every dollar lost to Medicare fraud is one less dollar available for our elderly or disadvantaged citizens needing health care. Are you willing to put up with that or do you want to do something about it?

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    What Happens When You Report Medicare Fraud

    After you report Medicare fraud, OIG staff review the complaint and send it to the right department for further investigation. The complaint resolution process may take six months or more.

    The OIG does not provide information about ongoing investigations, so until the complaint is resolved you wont be able to find out exactly how the investigation is going.

    How To Report Medicare Fraud Abuse And Waste

    Home / FAQs / General Medicare / How To Report Medicare Fraud, Abuse, and Waste

    Medicare fraud is a serious issue that you need to report. The Center for Medicare and Medicaid Services says fraud can cost taxpayers billions of dollars. It can also interfere with the health of Medicare beneficiaries. Thats taxpayer money thats going into the hands of unethical providers.

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    Reporting Medicare Fraud & Abuse

    Medicare fraud and abuse can happen anywhere, and usually results in higher health care costs and taxes for everyone. Some examples include:

    • A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got.
    • A provider that charges Medicare twice for a service or item that you only got once.
    • A person who steals your Medicare number or card and uses it to submit fraudulent claims in your name.
    • A company that offers you a Medicare drug plan that Medicare hasnt approved.


    What Is Considered Medicare Abuse

    Medicare & You: Preventing Medicare Fraud

    Abuse can be found when billing for unnecessary services or services that arent medically necessary occur. If youre overcharged for services or supplies, then youre a victim of Medicare abuse. However, if a provider misuses billing codes to increase reimbursement, the doctor commits Medicare abuse.

    Medicare wont use your name during the investigation of Medicare fraud, waste, or abuse if you dont want them to, you can remain anonymous.

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    Unethical Or Unsafe Behaviour By Health Professionals

    Unethical or unsafe behaviour by health professionals may include:

    • poor treatment, such as wrong or inadequate diagnosis or treatment
    • not giving enough information for example, about a diagnosis or treatment
    • inappropriate behaviour or relationship, such as a sexual relationship between a doctor and patient
    • a doctor working under the influence of drugs or alcohol

    If you want to report a health professionals unethical or unsafe behaviour, you can make a complaint to the Australian Health Practitioner Regulation Agency.

    How Do You Report Medicare Fraud Or Abuses

    Are you wondering how to report Medicare fraud? You can report Medicare fraud or suspected fraud in several ways:

    • Contact Medicare at 1-800-MEDICARE
    • Contact the Department of Health and Human Services Office of Inspector General at 1-800-HHS-TIPS
    • File a complaint online with the OIG to report any potential fraud, waste, and abuse
    • Contact the Senior Medicare Patrol for more help at 1-877-808-2468

    To report fraud, youll need:

    • Your Medicare number
    • Your providers name and information
    • Details about the fraudulent service
    • The payment paid by Medicare
    • The date of the service

    If you notice something unusual on your MSN, report the Medicare fraud or abuse as soon as possible.

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    Why It Is Important

    The Medicaid program is funded with both state and federal tax dollars. It is designed to pay for health care for low-income and vulnerable Floridians who need care. When people get benefits they dont deserve, or when providers are paid for services that were not supplied, it wastes your tax dollars and takes services away from those who need them.

    What You Need To Know About Medicare Fraud

    What is Medicare fraud and how do I report it?

    In July of 2017, the U.S. witnessed the largest healthcare fraud takedown this nation has ever seen. By the time this joint effort conducted by the Department of Health and Human Services Office of the Inspector General and state and federal law enforcement agencies was done, more than 400 defendants were charged in a court of law and accused of participating in some type of fraudulent Medicare and/or Medicaid scheme.

    What is perhaps most staggering is the amount of money alleged to be falsely billed by this collection of once-trusted medical professionals and agencies. The total? Somewhere around $1.3 billion.

    Medicare fraud is actually a blanket term encompassing different fraudulent activities related to the Medicare system.

    The large sums of money being scammed out of elderly people is part of the reason why Medicare Fraud Strike Force Teams across the country spend their days trying to shut down these types of dishonest healthcare professionals. In some cases, they net extremely positive results.

    For instance, as of mid-2018, there were already 11 court cases involving the Strike Force Teams where healthcare professionals committing fraudulent activities have either pleaded guilty to, been convicted of, or received a sentence for committing some form of healthcare fraud.

    What are these individuals doing that makes them guilty of Medicare fraud? There is a number of potential answers.

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    How To Report Medicare Fraud Or Abuse

    You have several ways to report suspected Medicare fraud or abuse:

    • For Original Medicare , call the Centers for Medicare & Medicaid Services at 800-MEDICARE
    • If youre enrolled in a Medicare Advantage plan , find your plan’s general contact and/or fraud-reporting information
    • If youre enrolled in a Medicare drug plan , call the Medicare Drug Integrity Contractor at 877-7SAFERX or find your plan’s general contact and/or fraud-reporting information

    For a faster and easier experience, try to have this information ready before you call:

    • Your name and Medicare number
    • The healthcare provider’s name and any other information you have
    • The service or item in question and when it was given
    • The payment amount approved and paid by Medicare
    • The date on your Medicare Summary Notice or claim

    Reporting Medicare Fraud Through The Office Of The Inspector General

    You may report fraud directly to the Office of the Inspector General through several avenues:

    • Contacting the Office of the Inspector General online

    Your call or inquiry to the Office of the Inspector General will remain confidential. You may also choose to report to the office anonymously. By reporting Medicare fraud to the Office of the Inspector General, you may be eligible for up to a $1,000 reward.

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    Where To Report Fraud & Abuse

    Report Medicaid provider fraud or patient abuse to the Attorney Generals Medicaid Investigations Division at 881-2320. You can also report fraud or abuse online HERE.

    Medicaid recipient fraud should be reported to the state Division of Medical Assistance by filing a complaint or by calling 1-800-662-7030. You can also report Medicaid recipient fraud to your local county Department of Social Services.

    To report Medicare fraud, contact the Office of Inspector General, US Department of Health and Human Services, at 447-8477.

    North Carolinians with information about Medicare error, fraud and abuse can also contact the North Carolina Senior Medicare Patrol Program at 408-1212.

    To report private insurance fraud, contact the NC Department of Insurance or call the department at 680-7684.

    To report fraud and abuse in state licensed facilities, agencies and nursing homes, contact the North Carolina Division of Health Service Regulation.

    How Can Healthcare Fraud And Abuse Be Prevented

    Medicare Fraud: Shut Down Fraudulent Calls (:15 seconds)

    Patients play an important role in preventing healthcare fraud and abuse. The best recommendation to prevent fraud is to be involved in your health care and review all your explanation of benefits and provider bills, Norce says. Being diligent in reviewing your care and claims as they happen is the best habit to develop in preventing fraud, as it will be easier to match the bills when your care is fresh in your memory.

    Medicare.gov recommends that you write down the dates you receive health care services on your calendar and save all of your receipts and statements from healthcare providers, Czajka says. That way, when your Medicare processes your claims, youll be able to verify you werent charged for services or products you didnt receive.

    Norce recommends all his clients who are on Original Medicare set up a MyMedicare.gov account. This will allow you to see your explanation of benefits in real time, he says. For Medigap, Medicare Advantage or Part D beneficiaries, he recommends creating an online account with your plan provider that will let you do the same process of matching bills, payments and claims.

    If you see something you dont understand or seems odd, the first step is to call the provider and request an explanation of services and costs, he says.

    Unless you have arranged for your providers to email and text you, avoid responding to anything outside of these trusted providers, Norce says.

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    Medicare Fraud: Protecting Yourself Begins By Protecting Your Card

    According to Medicare.gov, you should always treat your Medicare card like its a credit card. In other words, dont give the number out to just anybody, because theres a chance it could be used to open up a fraudulent claim.

    Medicare is so intent on stopping the frauds committed against the system that they even offer a 10 percent or $1,000 reward for sharing this type of information.

    Granted, it isnt possible to hide your number from your healthcare provider because he or she will need it for billing purposes. However, you dont want to give it out to anyone else, even if they offer you something of value in exchange for free medical care.

    But what if someone calls you saying theyre from Medicare and then requests your personal information over the phone? Medicare.gov says there are only two instances in which this agency will ever call you and request this type of information:

  • The first is if theyre from a Medicare plan that youre already a member of, which automatically rules out anyone who calls you about a plan that youre not currently on.
  • The other is if you called them and left them a message and they are calling you back.
  • Whom Do I Contact To Report Medicare Fraud

    En español | Fraud against Medicare usually committed by medical practitioners, equipment suppliers and related entities that claim money from Medicare for services they have not provided is a huge, multibillion-dollar industry. The Office of Inspector General of Medicare investigates and prosecutes many such cases, some of which are brought to light by Medicare beneficiaries who notice something that doesnt look right and report it. Often its the result of studying their Medicare Summary Notice and realizing that the statement is showing that Medicare paid for a service or item that they didnt receive.

    If you suspect a fraud has occurred, you should report it, providing as many details as you can, in any of the following ways:

    You are not required to identify yourself when reporting a suspected fraud, although keep in mind that the investigators may want to contact you for further information in order to pursue the case properly. If your suspicion is confirmed and leads directly to the recovery of Medicare money, you may get up to $1,000 as a reward.

    For more information on how to report fraud, see Center for Medicare & Medicaid Services’ guidance reporting fraud.

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    Tips For Staying Safe From Medicare Fraud

    Medicare officials will never correspond with you via phone or email, unless they are responding to a request you made for them to do so. In other words, Medicare will never call you out of the blue. This is very important to remember as you look to keep yourself safe from Medicare fraud, scams and abuse.

    Official communication from Medicare is by mail only, and a Medicare representative will never come to your door. Also, there is no such thing as a Medicare Part A or Part B sales representative.

    There are some additional things you can do and keep in mind to protect yourself from Medicare fraud:

    Lnea Directa De Comunicacin Del Oig Seccin De Operaciones


    Contactar la línea directa de comunicación del OIG es tan fácil. La línea directa de comunicación del OIG acepta la información y quejas de todas las fuentes sobre la posibilidad de fraude, despilfarro, abuso ó mala administración dentro de los programas del Departamento Estadounidense de Salud & Servicios Humanos .

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    Beware Of Identity Theft When Looking At Your Medicare Coverage Choices

    Remember to Guard your Cardkeeping your ID card and personal information secure at all times is very important:

    • No one should call you or come to your home uninvited to sell Medicare products.
    • Medicare plans cannot ask you for credit card or banking information over the telephone unless you are already a member of that plan.
    • In most cases, Medicare can’t call you to enroll in a planyou must call them.
    • Only give your information to doctors or other providers YOU KNOW, plans contracted by Medicare, and to people in the community who work with Medicare, such as your State Health Insurance Program or Social Security.

    If you think you’ve been a victim of identity theft or fraud and do not want to report it directly to UnitedHealthcare, you can also call any of these numbers/agencies below:

    • The Federal Trade Commission’s ID Theft Hotline toll-free at 1-877-438-4338 to make a report. TTY users, call toll-free 1-866-653-4261.
    • You can report potential prescription drug program fraud cases to the Medicare program directly, toll-free, at 1-877-7SafeRx . For potential medical or non-prescription fraud cases, report to the Medicare program directly, toll-free, at 1-800-MEDICARE , 24 hours a day, 7 days a week. TTY, call toll-free 1-877-486-2048, 24 hours a day, 7 days a week. The Medicare fax number is 1-717-975-4442 and the website is www.medicare.gov.

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