How to Report Medicare Fraud: Every Option Explained

You found charges on your parent's Medicare statement for a back brace they never ordered. Or a genetic testing kit they never requested. Or an office visit to a doctor they've never seen.

You know it's fraud. But where do you actually report it? The government has multiple agencies handling Medicare fraud, and knowing which one to contact — and in what order — can feel overwhelming when you're already dealing with the stress of protecting a vulnerable parent.

Here's a clear breakdown of every reporting channel, when to use each one, and what to expect after you file.

Start here: 1-800-MEDICARE

Phone: 1-800-633-4227 (TTY: 1-877-486-2048) Hours: 24/7, 365 days a year

This is your first call for any suspected Medicare fraud. The representatives can:

• Flag your parent's account for suspected fraudulent activity
• Help you understand charges on a Medicare Summary Notice
• Initiate a review of suspicious claims
• Connect you with your state's Senior Medicare Patrol
• Start the process for a new Medicare Beneficiary Identifier if the number was compromised

When you call, have your parent's Medicare card ready. Be specific about which charges look wrong: the date of service, the provider name, and the type of service or equipment listed. The more detail you provide, the faster the review process.

If your parent's Medicare number was shared with a scammer directly (for example, during a phone call from someone posing as Medicare), mention that explicitly. The steps for a compromised number are different from those for fraudulent billing discovered after the fact.

The HHS Office of Inspector General (OIG)

Phone: 1-800-447-8477 Online: oig.hhs.gov/fraud/report-fraud Mail: HHS OIG Hotline, P.O. Box 23489, Washington, DC 20026

The OIG is the federal agency that investigates Medicare fraud at scale. While 1-800-MEDICARE handles individual account issues, the OIG pursues the providers, companies, and criminal networks behind the fraud.

Report to the OIG when:

• A healthcare provider is billing Medicare for services not provided
• A company is cold-calling seniors to sell Medicare-covered equipment or tests (this is almost always fraudulent billing)
• You suspect a pattern — for example, the same company name appearing on multiple seniors' Medicare statements
• A doctor or clinic is prescribing unnecessary tests or equipment

The OIG hotline accepts anonymous tips. You don't need to provide your identity to file a report, though doing so allows them to follow up if they need additional information.

Medicare fraud whistleblower protections

If the person reporting fraud is a healthcare worker — a nurse, billing clerk, or administrator who has witnessed fraud from the inside — federal law provides significant whistleblower protections. The False Claims Act allows individuals to file "qui tam" lawsuits on behalf of the government and potentially receive 15-30% of any funds recovered. If a family member discovers that a provider is systematically defrauding Medicare, an attorney specializing in qui tam cases can advise on next steps.

Senior Medicare Patrol (SMP)

Phone: 1-877-808-2468 Website: smpresource.org

The SMP is a national program funded by the U.S. Administration for Community Living. Every state has an SMP office staffed by trained volunteers — many of them retired professionals — who help Medicare beneficiaries detect, report, and resolve fraud.

The SMP is especially useful when:

• You're not sure whether a charge is legitimate or fraudulent
• Your parent receives Medicare statements but doesn't understand them
• You want ongoing help monitoring your parent's Medicare account
• You need someone to walk you through the reporting process step by step

SMP volunteers will sit down with your parent's Medicare Summary Notices and go through them line by line. They know the common fraud patterns and can quickly identify charges that don't add up. This service is completely free.

The Federal Trade Commission (FTC)

Online: ReportFraud.ftc.gov

The FTC doesn't investigate individual Medicare fraud cases, but they collect complaint data that feeds into a national database used by over 3,000 law enforcement partners. Filing with the FTC is worth doing because:

• It contributes to pattern detection across the country
• It may trigger an investigation if multiple reports point to the same company or phone number
• It creates an official government record of the fraud

Filing takes about 10 minutes online. Include the phone number that called (if applicable), the company name used, what information was requested, and whether any money or personal data was exchanged.

State Attorney General

Every state has an Attorney General's office with a consumer protection or elder fraud division. Find yours at naag.org.

State AGs can:

• Investigate companies operating within the state
• Issue cease-and-desist orders
• File civil lawsuits against fraudulent operators
• Coordinate with federal agencies on larger investigations

Some states have dedicated elder abuse hotlines. If your parent is being targeted repeatedly, the state AG's office may be able to intervene more quickly than federal agencies.

Your parent's Medicare Advantage or Medigap insurer

If your parent has a Medicare Advantage plan (Part C) or a Medigap supplemental policy, contact that insurer's fraud department as well. Private insurers have their own fraud investigation teams and can flag or deny suspicious claims on their end. The insurer's customer service number is on the back of the insurance card.

What happens after you report

Medicare fraud investigations are slow. The OIG and state agencies may take months or years to build cases, especially when the fraud involves large networks. Here's what to expect:

Within 1-2 weeks: If you called 1-800-MEDICARE, the suspicious claims should be flagged and under review. Your parent won't be held responsible for fraudulent charges during the investigation.

Within 30 days: If you requested a new Medicare Beneficiary Identifier, the new card should arrive by mail.

Ongoing: Monitor your parent's Medicare Summary Notices every quarter. Set a calendar reminder to review them together. If new fraudulent charges appear, report them immediately — it may indicate the compromised number is still in circulation.

You won't get a verdict. Federal investigations rarely result in a phone call telling you "we caught the person." But your report matters. The OIG recovered over $1.6 billion in Medicare fraud judgments and settlements in fiscal year 2023. Every individual report contributes to the data that makes those recoveries possible.

Make it easier going forward

The best defense against Medicare fraud is ongoing monitoring. Many adult children set up online Medicare accounts for their parents and check claims monthly instead of waiting for quarterly MSN mailings. If your parent is willing, ask them to designate you as an authorized representative on their Medicare account so you can access claims directly.

If you want a printable system to stay on top of this — including a Medicare fraud checklist, scripts for calling the fraud hotlines, and the Refrigerator Defense Sheet with the rules your parent needs to remember — the Elder Scam Shield guide puts everything in one place for $14.