What is Medicare Fraud?

The majority of all Medicare payment mistakes are simply that - mistakes, a natural part of human error.  When these mistakes occur, they usually are not the result of providers, doctors or suppliers looking to take advantage of the system.  In most cases, these issues can be easily resolved by directly contacting the entity who provided you with a particular service. 

For the most part, providers, doctors and suppliers who tend to the needs of Medicare recipients do so with genuine purpose.  These people are committed to the cause, which is providing quality care to patients and making sure they are billed accurately.  On the other hand, you have a few malicious individuals that are intent on either abusing or defrauding the Medicare system.  Collectively, these people cheat the program for millions of dollars on an annual basis.  This means that millions of dollars are taken away from the program, cheating those who are in dire need of medical assistance.  Medicare fraud results in higher premium rates for innocent people who may not be effected directly, but end up suffering nevertheless. 

Making a Report

While providers, doctors and suppliers play a huge part in the process, as a Medicare beneficiary, you are the most essential link to detecting fraud.  Just think about it - you know better than anyone else if you did or did not receive healthcare services.  Upon receiving your Medicare Summary Notice, thoroughly review it to ensure that you understand all of the items and charges listed.  If a questionable procedure is listed, do not hesitate to contact your provider, doctor or supplier listed on the document.  Many times this is simply an error than can be rectified by phone. 

In the event that your provider, doctor or supplier can't help to resolve an issue and you suspect Medicare fraud, immediately write the entity that paid the claim. Information such as a name, address and telephone number should be easy to find on your Medicare Summary Notice. 

Before contacting the company that processes your Medicare claims, be sure to review the facts as you know them and as they are displayed on the Medicare Summary Notice.  It is very important to take note of the following:

the provider's name and your account or identifying number

the fee or service in question

the date on which the service is said to have occurred

the amount approved and paid by your Medicare provider

the date on your Medicare Summary Notice

the reason you are disputing the claim

any other information that proves the claim for service should have not been processed and paid by Medicare


If you are more comfortable writing instead of calling, be sure to clearly state in the letter that you are filing a fraud complaint.  This gives you more assurance that the complaint will be forwarded accordingly to the fraud unit.                

Below is the information you need to contact the United States HHS (Human and Health Services):

By Phone:

(800) HHS-TIPS (1-800-447-8477)

By Mail:    

Office of the Inspector General

HHS TIPS Hotline

P.O. Box 23489

Washington, DC 20026

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