How to Report Medicare and Medicaid Fraud
Report Medicare fraud to the HHS-OIG hotline or 1-800-MEDICARE and Medicaid fraud to your state's fraud control unit. Anonymous options, evidence, and rewards.
You can report Medicare fraud to the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG). You can file online at tips.oig.hhs.gov or call 1-800-HHS-TIPS (1-800-447-8477).
For Medicaid fraud by a provider, contact your state's Medicaid Fraud Control Unit (MFCU) or the same OIG hotline. You can give your name, file confidentially, or stay anonymous. Two separate routes can also pay a reward.
Where to Report Medicare and Medicaid Fraud
Report Medicare fraud to the HHS-OIG Hotline, and report Medicaid provider fraud to your state's MFCU or the same hotline. The HHS-OIG Hotline takes complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS programs. Use the table to match your situation to a contact.
| What Happened | Where to Report | How |
|---|---|---|
| A provider billed Medicare for care you did not get, or paid kickbacks | HHS-OIG Hotline | Online at tips.oig.hhs.gov; phone 1-800-447-8477; TTY 1-800-377-4950 |
| You suspect Medicare fraud and want to speak with Medicare | 1-800-MEDICARE | 1-800-633-4227 |
| Fraud tied to a Medicare Advantage or drug plan | Investigations Medicare Drug Integrity Contractor (I-MEDIC) | 1-877-7SAFERX (1-877-772-3379) |
| Medicaid fraud by a provider | Your state's MFCU, or the HHS-OIG Hotline | state MFCU directory |
| Abuse or neglect in a nursing home or long-term care facility | State MFCU or HHS-OIG Hotline; 911 for an emergency | MFCU directory or tips.oig.hhs.gov |
| A charge still looks wrong after you call the provider or plan | Senior Medicare Patrol (SMP) | 877-808-2468 |
Medicare.gov tells people who suspect fraud to call 1-800-MEDICARE, and it links to the same OIG online form. The OIG contact page lists two paper options.
- Mail: U.S. Department of Health and Human Services, Office of Inspector General, ATTN: OIG HOTLINE OPERATIONS, P.O. Box 23489, Washington, DC 20026.
- Fax: 1-800-223-8164, with a cover letter or the OIG complaint form. The OIG does not accept faxes over 45 pages.
Each state has a Medicaid Fraud Control Unit that investigates and prosecutes Medicaid provider fraud. MFCUs also handle abuse or neglect of residents in health care facilities. Units operate in all 50 states, DC, Puerto Rico and the U.S. Virgin Islands.
MFCUs usually sit inside the state attorney general's office. Each unit must be separate from the state Medicaid agency. Find your unit through the NAMFCU directory. NAMFCU itself does not accept complaints.
Check for a Billing Error First
Before you report, call the provider or plan to rule out a billing error. That is the first step suggested by the Senior Medicare Patrol. If the answer does not clear it up, contact your SMP, 1-800-MEDICARE or the OIG Hotline.
SMPs are grant-funded projects of the U.S. Administration for Community Living. They work in all 50 states, DC, Guam, Puerto Rico and the U.S. Virgin Islands. The national SMP number is 877-808-2468.
Medicare.gov lists prevention tips:
- Compare your Medicare statements against your own calendar or records.
- Give your Medicare number only to your doctor or people you know should have it.
- Refuse offers of money or gifts for free care.
- Medicare will never call you to sell you anything.
Write down the date and the billed service before you call.
What Counts as Medicare and Medicaid Fraud
The HHS-OIG lists these examples of what it investigates:
- False or fraudulent claims to Medicare or Medicaid.
- Kickbacks or inducements for referrals.
- Medical identity theft involving beneficiaries.
- A hospital failing to evaluate and stabilize an emergency patient.
- Abuse or neglect in nursing homes and long-term care facilities.
The U.S. Department of Justice (DOJ) names priority areas for its new tip rewards program. They include hospice fraud, home health care fraud and childcare subsidy fraud. Special services fraud, such as autism care, is also on the list.
Some problems belong with other offices. The OIG sends Medicare billing, coverage and lost-card questions to 1-800-MEDICARE. Social Security fraud goes to a different inspector general, covered in how to report Social Security fraud. For abuse of an older adult outside a facility, use the guide to reporting elder abuse.
What to Include in Your Report
A report should name the provider, describe what happened and when, and attach records that back it up. The OIG's before-you-submit page asks for four things.
- Who: The name and contact details of the person or business you suspect.
- What and when: A narrative of the nature, scope and time frame of the conduct, plus how you learned of it.
- Witnesses: Contact details for anyone who can corroborate your account.
- Evidence: Electronic files such as e-mails, documents, billing records or photographs.
Send copies only. The OIG does not return mailed originals.
If you use the SMP online form, leave out your Medicare number and Social Security number, as that form instructs. Keep your own copy of everything you submit, with the date.
Reporting Confidentially or Anonymously
The OIG gives three identity options when you report: no restrictions, confidential or anonymous. Pick one before you file.
| Option | Who Learns Your Name | Tradeoff |
|---|---|---|
| No restrictions | You set no limits on who learns it | The OIG lists no tradeoff for this option |
| Confidential | HHS-OIG only | The OIG may still disclose it if needed for the investigation or required by law |
| Anonymous | No one | Cannot be handled as a whistleblower-retaliation complaint |
The OIG says the confidential and anonymous options can hinder its review.
The False Claims Act protects employees who act against false claims. A fired, demoted or harassed employee can get reinstatement and two times back pay. The retaliation suit must be filed within 3 years. Read more about retaliation claims.
What Happens After You Report
Not every complaint is investigated. The Hotline does not confirm receipt or give status updates. Its decisions carry no appeal rights.
After at least six months, you may file a Freedom of Information Act (FOIA) request for records. The OIG rarely steps into personal or civil grievances.
MFCUs are not first responders. For an emergency, call 911, local police or Adult Protective Services.
Getting Paid for Reporting Health Care Fraud
The HHS-OIG, Medicare.gov, SMP and MFCU directory pages describe no reward for an ordinary report. Two separate routes can pay.
The first is the Justice Department's criminal tip rewards program. Its written guidance sets a reward of $10,000 to $30,000 for each distinct tip. The Justice Department can pay it when a tip about federal health care fraud leads to unsealed criminal charges. You do not have to wait for a guilty plea or sentencing.
Submit through the portal at america.gov/fraud. The Justice Department may deny an award solely because a tip came through another channel. To stay anonymous, you must submit through an attorney, who certifies your identity. Before any payment, the Justice Department must verify who you are.
Reported statements describe payouts in ways that differ from the written rules. AP reported that President Trump described payouts as a "1% commission" on the fraud a tip uncovers. NBC News reported he said he would be the "arbitrator" of award decisions. The written Justice Department guidance sets awards at $10,000 to $30,000, decided in the Department's sole discretion.
That written guidance governs submissions. Watch the Justice Department program page for updates. The fraud whistleblower incentive program guide covers eligibility in detail.
The second route is a False Claims Act (FCA) lawsuit called a qui tam. A private person, the relator, files a sealed complaint in federal court. The relator receives 15% to 25% of the recovery if the government takes over the case. If the government declines and the relator pursues it, the share is 25% to 30% (31 U.S.C. § 3730).
| Criterion | DOJ Tip Rewards Program | FCA Qui Tam Lawsuit |
|---|---|---|
| Payment | $10,000 to $30,000 per distinct tip | 15% to 30% of the government's recovery |
| Trigger | Unsealed criminal charges | A recovery in the civil case |
| Lawyer needed | No, except to stay anonymous | In practice, yes |
| Deadline | No fixed period. DOJ says tips must be timely so charges can be brought in time. | 6 years from the violation, or 3 years after the responsible official knew or should have known, whichever is later, with a 10-year outer limit |
The DOJ tip program does not fit everyone. People who meaningfully planned or profited from the crime are excluded. So are law-enforcement employees and their close relatives. Information learned as a compliance officer or internal auditor is generally not "original," with limited exceptions.
If the Justice Department revises its written guidance, the award amounts and rules could change. A tip reward does not bar later payments from other government whistleblower programs. Under the FCA's first-to-file rule, though, only the first relator can sue on the same facts. See the False Claims Act guide for how relator shares work.
If you have records showing false Medicare or Medicaid claims, you can get matched with a whistleblower or qui tam lawyer.
Frequently Asked Questions
Can you report Medicare fraud anonymously?
Yes, the HHS-OIG Hotline accepts anonymous complaints. The OIG says anonymous reports can hinder its review and cannot be handled as whistleblower-retaliation complaints. For a Justice Department tip reward, anonymity requires submitting through an attorney.
Will someone know if I report them for Medicaid fraud?
The confidential and anonymous options limit who learns your identity. With a confidential report, your identity is disclosed to HHS-OIG only. The OIG may still disclose your identity if the investigation needs it or the law requires it.
What evidence is needed to report Medicare fraud?
The OIG asks for the name and contact details of the person or business involved. Add a narrative of what happened, when, and how you learned of it, plus witness contacts. Attach copies of e-mails, documents, billing records or photographs, never originals.
What are some examples of Medicaid fraud?
The OIG lists false or fraudulent claims, kickbacks for referrals and medical identity theft. It also lists abuse or neglect in nursing homes and long-term care facilities. The Justice Department names hospice, home health and autism-care fraud as priority areas.
Do you get a reward for reporting Medicare fraud?
An ordinary hotline report carries no published reward. The Justice Department tip program can pay $10,000 to $30,000 when a tip about federal health care fraud leads to unsealed criminal charges. A False Claims Act relator can receive 15% to 30% of the government's recovery.
What happens after you report Medicare fraud?
Not every complaint is investigated. The Hotline does not confirm receipt, give status updates or allow appeals. After at least six months, you can file a FOIA request for records.
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