How to report Medicare and Medicaid fraud

U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG)

The OIG Hotline takes complaints online at tips.oig.hhs.gov or by phone at 1-800-HHS-TIPS, and you can report anonymously if you prefer; give the name of the provider or company involved, a full account of what happened, and any billing records you can attach. Calling the hotline alone pays you nothing, though a still-active CMS incentive program can pay up to $1,000 if your tip leads to a Medicare recovery of at least $100. The real money sits elsewhere: the same facts, filed instead as a qui tam lawsuit under the False Claims Act, can pay a relator 15% to 30% of what the government recovers, often far more than $1,000 on a case involving real billing fraud. Read our qui tam guide before you file anything with the hotline, since a lawyer needs to be involved from the start if you want to keep that option open.

What to gather first

• The name and contact information of the provider, facility, or company you're reporting
• A narrative describing what happened, when it happened, and how you found out
• Billing records, medical records, Explanation of Benefits statements, or claim numbers that support your account
• Contact information for anyone else who can corroborate the allegation

Report to the HHS-OIG hotline or call 1-800-447-8477

A reward may apply through the qui tam False Claims Act program.