Medicare Fraud is a complex issue. There are many components that must be present for a situation to meet the Centers for Medicare & Medicaid Services (CMS) criteria for Medicare fraud. Also, there are certain situations that have been specifically identified as customer service issues rather than fraud. Once a situation has been determined to be fraud, another complex question is where is the best place to report fraud. Good news! There are several best places to report Medicare fraud. One such place is the Office of Inspector General Fraud Hotline, 1.800.447.8477 (1.800.HHS.TIPS), fax 1.800.223.8164, e-mail htips@os.dhhs.gov or by mail:

Another best place is the carrier or intermediary who paid the bill. Their address is listed on your Medicare Summary Notice.

In order to help you determine if the situation is fraud, we are asking you to answer a series of five questions.

Was a payment made to a Medicare service provider?		Yes   No
Do you have a reason to believe that the Medicare service provider made a false statement or filed a false report?		Yes   No
Do you believe it is likely that the provider is intending to defraud Medicare?		Yes   No
Has an attempt been made to correct the situation with the provider?		Yes   No
If yes, was the situation resolved?		Yes   No