Medicare Fraud: What It Is and How to Report It Anonymously

In this article...
  • Medicare fraud costs billions of dollars each year. Learn how to spot Medicare fraud, how to protect yourself and how to anonymously report Medicare fraud to the proper authorities.

Every year, tens of billions of dollars of improper payments are issued by the Medicare program. And much of this waste can be attributed to Medicare fraud. 

Fraud is illegal and should be reported by anyone who suspects it. If you suspect Medicare fraud, call 1-800-MEDICARE (1-800-633-4227). TTY users may call 1-877-486-2048. 

You may also call the U.S. Department of Health and Human Services (HHS) Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users may dial 1-800-377-4950. 

You may also file an online Medicare fraud complaint. Or you can send an email to HHSTips@oig.hhs.gov or send a fax to 1-800-223-8164. 

If you suspect fraud taking place related to a privately sold Medicare Advantage (Medicare Part C) or Medicare Part D Prescription Drug plan, you should call the Medicare Drug Integrity Contractor at 1-877-7SAFERX (1-877-772-3379). 

Before you call, have these items ready:

  • Your Medicare number (which can be found on your Medicare card)
  • The name of the person, facility or company you suspect of fraud
  • The service or item in question and when it was administered or delivered
  • The payment amount of the transaction in question
  • The date given on your claim or Medicare Summary Notice that includes the transaction

Your report will be kept anonymous, and you’ll be protected from the suspected source that you are reporting. 

What Is Considered Medicare Fraud?

Medicare fraud can take many shapes, but it is commonly defined as someone knowingly deceiving Medicare in order to receive payment or reimbursement when they should not have, or to receive a higher payment or reimbursement than they should have. 

Some scammers also target Medicare beneficiaries and commit acts of Medicare fraud to cheat beneficiaries out of money or Medicare payments.

Fraudulent payments can come in the form of solicitation, receipt, offers or remuneration such as bribes, kickbacks or improper rebates. 

Doctors, pharmacies, other types of health care providers and even Medicare beneficiaries can all be guilty of committing Medicare fraud. 

Some examples of Medicare fraud include:

  • Billing Medicare for services you never performed or received
  • Billing Medicare for services that are different from the ones you performed or received 
  • Continuing to bill Medicare for rented medical equipment after it has been returned
  • Billing Medicare for medical equipment at a higher rate than what it actually cost, for a larger quantity than what was actually received or for a different item than what was received
  • Performing or offering unnecessary services in order to bill Medicare for them
  • Telling a beneficiary that Medicare will cover a particular service or item when it will not
  • Billing for medical appointments that never took place
  • Using another person’s Medicare number or card to receive care or items

Who Investigates Medicare Fraud?

Medicare fraud may be investigated by a handful of government agencies including the U.S. Department of Justice, the U.S. Department of Health and Human Services (HHS), the HHS Office of Inspector General and the Centers for Medicare and Medicaid Services. 

Medicare fraud can lead to imprisonment, fines and penalties, with both criminal and civil liability. 

Is there a Reward for Reporting Medicare Fraud?

Yes. The False Claims Act established a reward that can be given to someone who reports Medicare fraud. The reward equals 15-25% of what the government collects as a result of you reporting the instance of Medicare fraud.