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Clear out junk files and repair common Windows errorsFree Scan →Scan for outdated or missing drivers - takes under a minuteDriver Scan →If a Medicare or Medicaid claim looks wrong, first compare it with your appointments, receipts, and the care you actually received. A billing mistake can resemble fraud, so contact the provider when the entry may be an error. If the concern remains, use the reporting route for your coverage: Original Medicare through 1-800-MEDICARE or Medicare.gov, Medicare Advantage through the plan, Part D through the plan or I-MEDIC, and Medicaid through your state Medicaid agency. The federal HHS Office of Inspector General (HHS-OIG) also accepts Medicare and Medicaid complaints. Do not give a caller your Medicare number, Social Security number, or other sensitive information unless you independently verified who is requesting it.
- Save the claim or statement, appointment records, receipts, provider details, and dates.
- Report through an official number, website, plan contact, fax, or mailing address—not a link or phone number supplied by an unsolicited caller.
- Decide whether you want follow-up: HHS-OIG accepts anonymous reports, but contact information can help investigators ask questions and explain what happened next.
Choose the correct Medicare or Medicaid reporting route
The right destination depends on both the program and the type of coverage. Use this table as the routing decision before you disclose any personal information.
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| Coverage or issue | Primary route | Other official route | Important qualification |
|---|---|---|---|
| Original Medicare, Parts A and B | Call 1-800-MEDICARE (1-800-633-4227) or use Medicare.gov’s online fraud-reporting form. | HHS-OIG accepts a report by phone, online hotline, fax, or mail. | TTY for Medicare service is 1-877-486-2048. |
| Medicare Advantage, Part C | Contact the plan using its general customer-service or fraud-reporting information. | HHS-OIG can also receive a complaint. | The plan is the direct route for a plan-specific claim, provider, or conduct concern. |
| Medicare prescription drug coverage, Part D | Call I-MEDIC at 1-877-7SAFERX (1-877-772-3379). | Contact the Part D plan’s fraud-reporting channel or HHS-OIG. | Use the plan route when the issue concerns a plan’s pharmacy, billing, or enrollment activity. |
| Medicaid | Contact the Medicaid agency in the state that administers the coverage. | HHS-OIG also accepts Medicaid reports. | State programs have different contacts; use the current state resource rather than an old directory. |
| Unclear program, suspected organized fraud, or concern involving more than one program | HHS-OIG: 1-800-HHS-TIPS (1-800-447-8477), TTY 1-800-377-4950, or its online hotline. | Fax 1-800-223-8164 or mail OIG Hotline Operations, P.O. Box 23489, Washington, DC 20026. | CMS says fax reports are limited to 10 pages. HHS-OIG accepts anonymous reports. |
| Help understanding or preparing a Medicare report | Senior Medicare Patrol: 1-877-808-2468 and its local assistance program. | Use Medicare’s or CMS’s official reporting information for the actual complaint. | The program helps people identify and report suspected fraud; it does not replace the agency or plan that investigates. |
CMS’s Reporting Fraud page, last modified March 4, 2026, describes these program and plan routes. The CMS Medicaid Integrity Program page, last modified November 14, 2024, explains that each state administers Medicaid and directs beneficiaries to state resources. The April 2026 Medicare Learning Network edition also describes HHS-OIG’s anonymous-reporting option and Senior Medicare Patrol assistance.
Check whether the entry is an error before calling it fraud
Match the claim to what happened
Review the Medicare Summary Notice, electronic claim information, explanation of benefits, pharmacy record, or Medicaid statement. Compare each unfamiliar line with your calendar, appointment confirmations, receipts, transportation records, and the services you remember receiving. Write down the date of service, provider or facility name, service description, amount, and the reason it appears wrong. A claim posted under a group practice, laboratory, ambulance company, or billing contractor may look unfamiliar even when the underlying service was legitimate, so check the details before concluding that someone acted intentionally.
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Ask the provider about a possible billing mistake
Medicare.gov advises calling the provider’s office when a claim may be an error. Ask the billing department to explain the code, date, units, and provider listed. Keep the conversation factual: identify the line item, say whether you received the service, and request a corrected claim if the office confirms a mistake. Do not let a provider’s explanation prevent you from reporting a concern that still appears improper; the purpose of the call is to distinguish a correctable billing problem from conduct that warrants an investigation.
Create a contemporaneous file
Keep copies or screenshots of the statement, invoices, letters, emails, and text messages. Record when you noticed the issue, who you contacted, what was said, and any promised correction. Preserve the original files rather than editing them. This record helps you describe a pattern if several claims are involved and gives an agency a reliable chronology.
How to submit a report through each channel
Original Medicare
Call 1-800-MEDICARE or use the online reporting form linked from Medicare.gov. Have the claim information and your notes available, but disclose only what the verified Medicare channel requests. If you use telecommunications relay service, Medicare lists TTY 1-877-486-2048. Ask for a confirmation or reference number and write down the date and time of the contact.
Medicare Advantage
Find the plan’s current general-contact or fraud-reporting information on your member materials or the plan’s verified website. Explain that the matter concerns Medicare Advantage and provide the claim number, date, provider, and facts supporting your concern. A plan may need to investigate its contracted provider or correct a claim in its own system. You may also submit the facts to HHS-OIG when the concern involves suspected fraud, abuse, or conduct beyond a routine plan correction.
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Part D prescription drug plans
For a Part D concern, call I-MEDIC at 1-877-7SAFERX (1-877-772-3379) or use the plan’s fraud-reporting contact. Identify the prescription, pharmacy, prescriber, date, and charge that you do not recognize. Do not send a photograph of your card or a full Social Security number merely because a message asks for it; verify the recipient first and provide only information needed to locate the claim.
Medicaid
Start with the Medicaid agency in the state administering your coverage. State agencies maintain their own current phone numbers, web forms, and mailing instructions, and those details can change. CMS’s Medicaid Integrity Program page is the appropriate starting point for locating the live state resource. If the allegation involves a provider serving multiple states, a scheme affecting both Medicaid and Medicare, or another federal concern, you can also report it to HHS-OIG.
HHS-OIG
HHS-OIG takes reports by phone at 1-800-HHS-TIPS, by TTY at 1-800-377-4950, through its online hotline, by fax at 1-800-223-8164, or by mail to OIG Hotline Operations, P.O. Box 23489, Washington, DC 20026. CMS states that fax submissions are limited to 10 pages. Include a concise description, the people or organizations involved, dates, locations, claim or invoice details, and copies of supporting material when the channel permits them. Do not mail original documents that you cannot replace.
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Senior Medicare Patrol assistance
Senior Medicare Patrol can help a person with Medicare understand a statement and prepare a suspected-fraud report. Call 1-877-808-2468 or use the program’s local locator. Treat this as preparation and education assistance; send the actual complaint to Medicare, the relevant plan, the state Medicaid agency, or HHS-OIG.
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What to include in a useful report
There is no single reporting template identified by the reviewed federal guidance. A clear report normally answers these questions:
- Who: beneficiary, provider, facility, pharmacy, plan, marketer, or caller involved.
- What: service, prescription, enrollment action, payment, or use of an identification number that appears improper.
- When and where: dates of service, dates of calls or visits, and the state or facility location.
- Why it is suspicious: for example, a service you did not receive, duplicate billing, an altered statement, or an attempt to obtain your identification details.
- Evidence: claim lines, receipts, letters, caller IDs, voicemails, emails, and names of people you already contacted.
Separate what you personally observed from what someone told you. Use phrases such as appears, I do not recognize, or I did not receive when that is the accurate level of certainty. Do not exaggerate, guess at losses, or accuse a person when the records establish only an unexplained entry.
Choose between an anonymous and an identified report
HHS-OIG accepts anonymous complaints. An anonymous submission can reduce the amount of personal information you disclose, but investigators may be unable to ask clarifying questions, obtain additional documents, or tell you whether a matter was resolved. If you want follow-up, provide a safe contact method and state any limits on when or how you can be reached. You can ask the receiving agency or plan what information is optional before supplying it.
Keep the reference number, submission receipt, or confirmation screen. Record the agency or plan, contact method, date, and the name or ID of the representative. A reference number is not a finding that fraud occurred; it simply helps locate your report.
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Protect your Medicare, Medicaid, and Social Security information
Recognize medical identity theft
Medicare.gov defines medical identity theft as using a person’s information without consent to commit Medicare fraud or another crime. Warning signs include claims for services you did not receive, statements from providers you never visited, unexplained prescription activity, or a caller who already knows some of your personal details and asks for the rest. Review provider receipts and statements routinely. A secure Medicare.gov account lets you view processed Original Medicare claims sooner than waiting for paper materials.
Give identifying information only to verified recipients
Medicare.gov advises giving your Medicare card or number and Social Security information only to a doctor or other people you know should have it, such as an insurer acting on your behalf or an appropriate Medicare helper. Before giving details to an agency, plan, or counselor, independently obtain the contact information from your card, a statement, or an official government page. Do not rely on a link in an unexpected email or text.
Handle unsolicited calls, visits, and offers safely
Medicare says it will never call to sell you something or visit your home. It may call in limited circumstances, including following up after you contacted Medicare. That distinction matters: an unexpected sales call claiming to be Medicare is not made trustworthy merely because the caller knows your name. End the call, do not press keys that disclose information, and call the verified number yourself.
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Do not accept money or gifts in exchange for free medical care. Do not let an unauthorized person review your medical records or recommend services. Do not join a plan over the phone unless you initiated the call and requested help. These precautions reduce the chance that someone will use a sales pitch, a purported benefit, or a free-service offer to obtain your identifiers or induce unnecessary care.
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If a card or number may already have been misused
Save the suspicious communication and review recent claims and statements. Report the concern through the appropriate Medicare, plan, Medicaid, or HHS-OIG route, describing exactly which information may have been exposed and which claims you do not recognize. Follow the agency’s instructions for correcting records and monitor later statements for additional activity. Do not post your Medicare number, Social Security number, or complete member ID in a public forum or send it to an unverified helper.
What happens after you report
The receiving organization may ask for more documents, refer the matter to another office, correct a claim, or investigate a broader pattern. Response times and outcomes vary, and the agency may not disclose investigative details. Continue paying attention to new statements while the report is pending. If a provider promised to correct a claim, check a later statement to confirm whether the correction appeared rather than assuming the conversation resolved it.
Keep your chronology until the matter is closed or you no longer need it for an appeal, claim correction, or identity-theft follow-up. If you receive a new suspicious claim, add it as a separate dated entry and tell the agency that it may be related to an earlier report. Do not repeatedly submit identical reports through every channel unless a representative directs you to; duplicate submissions can make the record harder to follow.
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Quick Recap
Practical decision guide for common situations
An unfamiliar office appears on an Original Medicare statement
- Check the date, procedure, ordering clinician, and place of service against your records.
- Call the provider’s billing office using a number you independently verified.
- If the explanation does not resolve the discrepancy, report it through 1-800-MEDICARE or Medicare.gov and consider HHS-OIG.
A caller offers a free medical device or asks for your Medicare number
- Decline and end the call; do not confirm your address, date of birth, Medicare number, or Social Security number.
- Save the caller ID, voicemail, written message, or other details.
- Report the solicitation through an official Medicare or HHS-OIG route if it involved suspected fraud or attempted misuse.
A Part D prescription or pharmacy charge is not yours
- Compare the drug, pharmacy, prescriber, fill date, and quantity with your medication records.
- Contact the Part D plan or I-MEDIC using the verified contact information.
- Monitor later prescription statements for additional unfamiliar activity.
A Medicaid claim is unfamiliar
- Confirm which state administers your Medicaid coverage and locate its current agency contact.
- Ask the provider whether the line is a billing error.
- Report unresolved or intentional-looking conduct to the state agency, with HHS-OIG as an additional federal option.
Common mistakes that can weaken a report
- Reporting before checking the service: an unfamiliar provider name or billing code is not, by itself, proof of fraud.
- Using an old state number: Medicaid contacts are state-specific and can change; use the current resource.
- Responding to the suspicious contact: an unsolicited caller’s callback number or web link may be the very thing you need to avoid.
- Sending more data than necessary: provide claim facts and requested documentation, not an unredacted file containing unrelated family members’ information.
- Assuming an anonymous report guarantees updates: without contact details, investigators may have no way to ask questions or report progress.
- Discarding records after a phone call: retain statements, correspondence, dates, and reference numbers until the issue is resolved.
Key contacts at a glance
| Contact | Number or address | Use |
|---|---|---|
| Medicare service | 1-800-MEDICARE (1-800-633-4227); TTY 1-877-486-2048 | Original Medicare questions and suspected-fraud reports |
| HHS-OIG | 1-800-HHS-TIPS (1-800-447-8477); TTY 1-800-377-4950 | Medicare or Medicaid complaints, including anonymous reports |
| HHS-OIG written channels | Fax 1-800-223-8164; OIG Hotline Operations, P.O. Box 23489, Washington, DC 20026 | Written complaint; CMS limits fax reports to 10 pages |
| I-MEDIC | 1-877-7SAFERX (1-877-772-3379) | Part D prescription-drug fraud concerns |
| Senior Medicare Patrol | 1-877-808-2468 | Help identifying and preparing a Medicare fraud report |
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