A reader’s comment this week raised the question of how the public can report suspected Medicare, Medicaid, or health-care fraud. This article takes a brief look at some of the state and federal agencies that deal with such civil or criminal violations.
The United States Department of Health and Human Services (HHS) gives an overview of Medicare fraud on the HHS.gov website. The website also instructs visitors on how to report Medicare fraud. The instructions include telephone and fax numbers and addresses for email and regular mail.
The website of the Centers for Medicare & Medicaid Services (CMS) contains information and contacts with regard to fraud in the Medicaid Program. The CMS resources include instructions on how to report suspected fraud and a database of contacts in each state or territory. The instructions may be helpful to visitors who have difficulty with the contacts database.
The HHS Office of Inspector General (OIG) maintains a hotline for reports of fraud in HHS departments and programs. Among other functions, the OIG reviews state laws related to false or fraudulent Medicaid claims.
The stopmedicarefraud.gov website of HHS and the U.S. Department of Justice highlights current efforts of law enforcement to fight Medicare and Medicaid fraud. Health-care fraud is, furthermore, among the white-collar crimes on which the Federal Bureau of Investigation focuses.
On the state level, the anti-fraud efforts of Texas and California serve as examples. The Office of the Attorney General of Texas has boasted that its Civil Medicaid Fraud Section “is nationally recognized as a leader in the recovery of funds wrongfully taken from the Medicaid program.” In addition to civil Medicaid fraud, the Texas Medicaid Fraud Control Unit deals with criminal Medicaid fraud through its field offices in several cities throughout the state.
The Office of the Attorney General of the State of California currently provides online information about Medi-Cal fraud. The Bureau of Medi-Cal Fraud & Elder Abuse now takes reports of suspected Medi-Cal fraud or elder abuse by mail, telephone, or online complaint.
These are not the only ways to report Medicare, Medicaid, or health-care fraud. Your state or territory likely has its own agency or department that deals with such cases. Other federal agencies may also be involved with particular complaints.
These resources should, however, help you get started if you wish to report suspected civil or criminal violations. Although a civil or criminal investigation could take months or even years, the participation of you and your neighbors will be a step forward in the fight against fraud.
National Health Care Anti-Fraud Association
The Legal Information Institute of Cornell University offers an overview of healthcare fraud
SMP programs help Medicare and Medicaid beneficiaries fight health-care fraud
Comments
Another way to report Medicare and Medicaid fraud is to contact your local SMP (Senior Medicare Patrol) Program. The SMP programs are funded by the U.S. Administration on Aging to empower consumers to prevent, detect, and report health care fraud through outreach and education. There are SMP programs in every state, as well as in Washington D.C., Puerto Rico, Guam, and the Virgin Islands. To find your state's SMP, or for more information, please visit the national SMP website at www.smpresource.org.
Thank you for the suggestion, Erin. I have added a link to the SMP website.
Thanks!
Erin forwarded me the link to this article and her comment. We are the Texas SMP headquartered right here in Houston if you want more information or if you want to post our number to report Medicare fraud locally, it is 713-341-6184 0r 1-888-341-6187.
Hi -- this is Lisa Stansbury with Louisiana Health Care Review and the Senior Medicare Patrol in Louisiana. You can call 1-877-272-8720 with any questions about Medicare fraud in our state.
We are also recruiting volunteers to conduct group education sessions, community outreach events and one-on-one counseling to equip seniors with the information needed to protect themselves from Medicare fraud, errors and abuse.
To report complaints about Medicare Advantage (Part C) and Medicare Part D fraud, waste and abuse, the beneficiary can contact the Medicare Drug Integrity Contractor (MEDIC) directly at 1-877-7SAFERX or 1-877-772-3379. The MEDIC has been tasked with performing fraud, waste and abuse detection and prevention activities for Part C and Part D across the country.
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