How to Report Fraud and Suspected Fraud

The Medicaid program provides health benefits to low-income families who either have no medical insurance or have inadequate medical insurance.  The federal government establishes the general Medicaid guidelines; however the program requirements are established and monitored by each individual state.

Do You Suspect Medicaid Fraud?

Healthcare fraud, waste, and abuse can involve physicians, pharmacists, beneficiaries, and even medical equipment companies.  Success in combating healthcare fraud, waste, and abuse is measured not only by convictions, but also by effective deterrent efforts.

Anyone suspecting Medicaid fraud, waste, or abuse is encouraged to report it.  The first touch point should be the Program Integrity contact in the State Medicaid Agency for your individual state.  The State By State Fraud and Abuse Reporting Contacts document was last updated October 2014, and includes the contact information for the State Medicaid Agencies (SMA), and the Medicaid Fraud Control Units (MFCU).  Another reporting option is to visit CMS' State Contacts Database which requires entering the State, Contact Type, and Organization Type.  Lastly, the Office of Inspector General's (OIG) National Fraud Hotline is:

Dial: 1-800-HHS-TIPS

(1-800-447-8477)

Or visit their website at: Office of Inspector General - Report Fraud

To facilitate expeditious investigation of the alleged fraud, it is helpful to have as much information as possible.  Pertinent information includes:

• Name of Medicaid client
• Client's Medicaid card number
• Name of doctor, hospital, or other healthcare provider
• Date of service
• Amount of money Medicaid approved and/or paid; and
• A description of the acts that you suspect involve fraud