How to Report Suspected Medicare Fraud
Short answer
Suspected Medicare fraud should be documented and reported through official channels. Billing errors, coverage disputes and fraud are not interchangeable, so first identify whether the concern involves intentional deception, an ordinary claim error or a coverage decision.
Coverage And Action
Review the MSN or plan EOB, record provider names, dates, services and communications, and contact the provider first when an innocent billing error is plausible. Suspicious Medicare claims can be reported to 1-800-MEDICARE; suspected federal health-care fraud can also be reported to HHS OIG.
Not Automatic
An unfamiliar claim is not proof of fraud. Do not accuse a provider or agent publicly based only on a coding discrepancy or unexplained statement.
Practical Example
If an MSN lists DME you never received, preserve the statement and supplier information and report the unexplained claim rather than paying or ignoring it.
Questions to verify
- Did I receive the service or item?
- Could this be a billing/coding error?
- What evidence should I preserve before reporting?