How to Report Medicare Fraud
You can report Medicare fraud to the Department of Health and Human Services Office of Inspector General hotline at 1-800-HHS-TIPS, or file a qui tam case under the False Claims Act through an attorney. Only the qui tam route pays an award, 15 to 30 percent of the recovery, and provides anti-retaliation protection.
The two routes are not equivalent
Calling the hotline reports the conduct. It does not preserve your right to an award, does not establish you as first to file, and does not by itself trigger the False Claims Act anti-retaliation protections tied to acting in furtherance of a case.
Filing a qui tam case does all three. If there is any prospect that you want an award or need protection, the order in which you do things matters.
What qualifies as Medicare fraud
The conduct has to involve a false claim for federal money rather than poor care alone.
- Billing for services, visits, or supplies that were never provided
- Upcoding to a higher-paying service level than was delivered
- Billing medically unnecessary tests, procedures, or admissions
- Kickbacks for referrals, prescriptions, or product selection
- Unsupported diagnosis codes submitted to raise Medicare Advantage risk scores
- Billing for services by unlicensed or unsupervised staff
- Retaining a known overpayment rather than returning it
Before you report, in order
The sequence protects both you and the case.
- Write down what you know, with dates, names, and how you learned it
- Do not access records or systems beyond your normal authorization
- Do not discuss it with coworkers
- Speak with a whistleblower attorney about which route fits and what filing first means
- If a case is viable, file under seal before making any public or internal report that could expose you
What happens after a qui tam filing
The complaint goes to the court and the Department of Justice under seal. Your employer is not told. The government investigates with the HHS Office of Inspector General, which usually takes one to three years, then decides whether to intervene.
You keep working throughout. If you are retaliated against, section 3730(h) provides reinstatement, two times back pay, and attorney fees as a separate claim.
Frequently asked questions
Can I report Medicare fraud anonymously?
The OIG hotline accepts anonymous tips, but anonymous reports cannot receive an award and are harder to investigate. A qui tam case is filed under seal, so your employer does not learn of it during the investigation, though your name becomes known if the case proceeds.
How much can I receive for reporting Medicare fraud?
15 to 25 percent of the government recovery if it intervenes, and 25 to 30 percent if you proceed alone. Hotline reports do not carry an award.
Do I need proof before I report?
You need specific, non-public information sufficient to plead fraud with particularity: what was billed, by whom, when, and why it was false. You do not need complete proof, and you should not collect documents you are not authorized to access.
What if someone already reported the same fraud?
Only the first relator to file can recover. That is the first-to-file rule and it is the reason delay carries real cost.
The attorneys who handle these cases
Related reading
Talk to a whistleblower attorney before you report
A conversation costs nothing and is confidential. We will tell you honestly whether what you have describes a case, and what the first-to-file rule means for your timing.