How to Report Medical Fraud

Medical insurance fraud is committed in a number of ways. For instance, when a consumer files a claim for services or prescription drug he never received or a provider bills for a service it never actually provided, a crime has been committed. Anytime a consumer or provider knowingly presents to her insurance company false information with the intent of receiving health care benefits, medical insurance fraud has occurred. According to Cornell University Law School, "statistics now show that 10 cents of every dollar spent on health care goes toward paying for fraudulent health care claims." Such unscrupulous acts need to be reported.

Things You'll Need

• Internet access
• Telephone

Instructions

1. Find the insurance fraud bureau for your state. This can be located on the Coalition Against Insurance Fraud website using the link in Resources. If your state does not have an insurance fraud bureau, search for your state's department of insurance website.

2. Call the hotline number listed for your state insurance fraud bureau or the consumer helpline found on your state's department of insurance website. You will want to provide the agency with the name or any details and information you have about the medical insurance fraud situation.

3. Contact the insurance company you believe the fraudulent activity occurred against. You can locate a company's phone number by finding its corporate homepage on the Internet.

4. Report Medicare or Medicaid fraud by calling the Department of Health and Human Services' Office of Inspector General Fraud Hotline. You can either call 800-447-8477 or email [e-mail]. You will need to provide information such as who committed the fraud and where and how it happened. Plus, according to Medicare, "your identity will be protected to the maximum extent allowed by the law."

5. Voice your concerns to the National Insurance Crime Bureau (NICB). You can submit the information via the link in Resources or call the bureau's national hotline at 800-835-6422. If you are using a cell phone, you can send a text by typing the word "FRAUD" and then the fraudulent information you are reporting in the message section. The text is sent to TIP411 (847411). You are allowed to keep your identity anonymous when reporting fraudulent information.

References

• Cornell University Law School: Healthcare Fraud
• Coalition Against Insurance Fraud: Report Fraud

Resources

• Coalition Against Insurance Fraud: State fraud bureaus
• Medicare: How to Report Medicare Fraud
• National Insurance Crime Bureau: Speak Up