How to Report Fraud

A federal fraud investigation is a serious and lengthy process. Below are some questions to consider before reporting the issue to help determine if the issue is fraud related:

• Did you contact the provider? What did he/she say?
  If you are uncertain about your statement, you should first contact the provider for more information.
• Do you see an error on your Medicare Summary Notice (MSN)?
  If you see a charge on your MSN that may be wrong, call your doctor, hospital, or other provider or supplier and ask about it. Many times an error has been made in billing and can be corrected.
• Are there incorrect dates of service?
  Be sure to check the dates of service on your MSN. Contact your provider if you recall having the service, but not on the date listed on the MSN.
• Did you receive two bills for the same services?
  Sometimes when you receive services in a hospital or your doctor’s office, you will receive two statements – one from the doctor and one from the facility. This usually happens when you receive services such as labs, x-rays, anesthesia, and other services. This often happens when your doctor’s office is in a hospital or if you get lab services and the doctor sends the samples to another provider for the results. Usually, when you receive x-rays and other tests in a hospital, the doctor will bill for reading the test and the hospital will bill for using the equipment. If you are uncertain about your statement, it is best that you contact the provider to get more information. This could be a simple billing error that the provider can correct or help you to better understand.
• Do you recognize the provider’s address on your statement?
  Many providers have an office separate from the one that patients normally visit to handle medical billing. You should verify the practice location address (this is usually where the services were rendered). If you recognize the charges but not the address, this is usually not a fraud issue. If you are uncertain about your statement, it is best that you contact the provider for more information to help you better understand.
• Do you know the provider?
  If you recognize the charges on your statement but not the doctor, you should call your provider for help. Sometimes when you get services in a hospital, the lead doctor will sign off on all of the paperwork even though you were treated by another doctor.

HHS Tips Hotline

After reviewing the list of questions above, if you would like to still report your issue to the Office of Inspector General (OIG) Fraud Hotline, their contact information is:

Office of Inspector General (OIG) Fraud Hotline
Phone: 1-800-HHS-TIPS (1-800-447-8477)
TTY: 1-800-377-4950
Fax: 1-800-223-8164
Email: HHSTips@oig.hhs.gov
Address:
HHS Tips Hotline
P.O. Box 23489
Washington, DC 20026-3489

The following is the information you should have when contacting the OIG:

• Who committed the fraud?
• Who are the victims
• What exactly did the suspect do?
• Where did the fraud take place?
• When did it happen?
• How was the fraud committed?
• Do you know why the person committed the fraud?
• Who else has knowledge of the possible violation?

Your identity will be protected to the maximum extent allowed by the law. Your identity will be released only to those officials who have a need to know.

You should not release your personal information to anyone. If someone calls or comes to your house, it is important not to give him or her any of your information.

Florida’s Medicare Fraud Hotline

There is a toll-free hotline to report any suspicious charges billed by providers or suppliers if:

• You are a Florida resident and would like to report Durable Medical Equipment fraud.
• You have received Part A or Part B services in Florida and would like to report fraud.

Please call 1-800-MEDICARE to help determine if your issue should be referred to the Florida Medicare Fraud Hotline.