You have several ways to report Medicare fraud, which along with errors and abuse cost Medicare billions of dollars each year.
If you suspect fraudulent activity, you can contact Medicare’s help line, the U.S. Department of Health and Human Services or your local State Health Insurance Assistance Program (SHIP). However, a good place to start is the Senior Medicare Patrol program, which the federal government finances but the states operate.
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Identifying fraud isn’t always easy. Common scams include charging Medicare for services or supplies not provided, inflating costs of medical equipment and misrepresenting a diagnosis so Medicare will pay for unnecessary procedures and tests, some never performed.
Medicare identity theft is common, too. ID thieves offer seemingly free medical equipment so they can steal Medicare beneficiaries’ numbers and create fake claims.
Staying ahead of scams is easier said than done, but reviewing your Medicare summary notice, which is mailed to you every three months to identify services and supplies billed to Medicare, is a good way help you protect yourself.
If you suspect fraudulent activity on your Medicare account, have questions about suspicious charges or have been contacted by someone who tried to steal your Medicare number, you can report the problem in several ways.
Senior Medicare Patrol. The best first step is to contact the Senior Medicare Patrol (SMP). These organizations, which are financed by grants from the federal government, are available in every state, as well as the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands.
Local volunteers and staff help educate, detect and report Medicare fraud. Each state has a hotline for you to report suspected fraud and ask questions about possible scams. Volunteers and staff can help you gather evidence and guide you through the next steps. Find contact information for your state on the SMP resource center website or by calling 877-808-2468.
You can also report Medicare fraud directly to the following agencies, depending on the type of fraud. The volunteers can help you decide whom to contact and work with you to make the calls.
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Medicare’s help line, 800-633-4227. You can call Medicare directly to ask questions or report fraudulent activity on your Medicare Summary Notice. You may also need to work with Medicare to clear up your record if someone has been making phony charges in your name, which could affect your coverage. See Medicare’s guide to reporting fraud for more information.
U.S. Department of Health & Human Services fraud hotline, 800-447-8477. You can file an online report with the HHS Office of Inspector General, which investigates fraud. You’re not required to identify yourself when reporting a suspected fraud although investigators may want to contact you for further information to pursue the case properly.
Vision insurance plans designed for members and their families See more Insurance offers >Private plans for Medicare Advantage or prescription drugs. If you find suspicious activity on your Medicare Advantage or Part D explanation of benefits, you can contact the plan directly.
You can also report Part D fraud at 877-772-3379. If you suspect you’ve been fraudulently enrolled in a plan or would like to report misleading marketing materials or attempts to enroll people in a Medicare Advantage or Part D plan without their knowledge, contact Medicare or your Senior Medicare Patrol.
State Health Insurance Assistance Program (SHIP). Counselors have technical knowledge about Medicare and often work with local Senior Medical Patrols. Find local SHIPs at www.shiphelp.org or by calling 877-839-2675.
Because Medicare is usually billed for services and you may never see charges or pay money yourself, Medicare fraud can go undetected. Regularly review your Medicare summary notice for any suspicious activity, especially if you see that Medicare paid for a service or item you didn’t receive.
Original Medicare enrollees receive this notice in the mail every three months if Medicare was billed for any services or medical supplies during that period. Typically, it lists Medicare charges billed, what it paid and the maximum amount you may owe a provider. Or you can sign up to receive electronic notices, which you'll receive every month. You can also access claims information in your online Medicare account within 24 hours of when Medicare processes them.
Medicare Advantage and other private plans issue their own explanation of benefits, so review those thoroughly for suspicious activity as well.
