How to Report
You, as the Medicare beneficiary, are the most important link in finding Medicare
fraud. You know better than anyone what healthcare services you have received.
Review your Medicare Summary Notice when you receive it, and make sure you understand
all of the items listed.
If you don’t remember a procedure that is listed, you should first call your
physician, provider, or supplier that is listed on the Medicare Summary Notice.
Many times a simple mistake has been made and can be corrected by your physician,
provider, or supplier’s office when you call.
If your physician, provider, or supplier’s office does not help you with the
questions or concerns about items listed on your Medicare Summary Notice and
you still suspect Medicare fraud or if you cannot call them, you should call or
write the Medicare company that paid the claim. The name, address, and
telephone number are on the Medicare Summary Notice (MSN)
you receive, which shows what Medicare paid.
Before contacting the Medicare claims processing company, carefully review the facts
as you know them and as shown on the Medicare Summary Notice. Write down:
- The provider's name and any identifying number you may have.
- The item or service you are questioning.
- The date on which the item or service was supposedly furnished.
- The amount approved and paid by Medicare.
- The date of the Medicare Summary Notice.
- The name and Medicare number of the person who supposedly received the item or
- The reason you believe Medicare should not have paid.
- Any other information you may have showing that the claim for the item or
service should not have been paid by Medicare.
If you plan to write rather than call, clearly state at the beginning of your
letter that you are filing a fraud complaint. This will help to ensure that
your complaint is forwarded to the fraud unit.
Office of Inspector General Hotline
To further assist you, the Office of the Inspector General maintains a hotline,
which offers a confidential means for reporting vital information. The Hotline can
(no more than 10 pages please)
Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
If you are attempting to report specific information proving Medicare fraud,
please provide as much identifying information as possible regarding your
concern. Such information should include subject's name, address and phone
number etc. Details regarding the allegation should include the basics of
who, what, when, where, why, and how.
Please note that it is current Hotline policy not to respond directly to
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