About Reporting Medicare Fraud

According to Medicare: Fraud is defined as an intentional deception or misrepresentation that the individual makes, knowing it to be false and that it could result in some unauthorized benefit to them.

Abuse describes incidents or practices of providers, physicians or suppliers, or services and equipment which, although not usually fraudulent, are inconsistent with accepted sound medical, business or fiscal practices. These practices may, directly or indirectly, result in unnecessary costs to the program, improper payment, or payment for services which fail to meet professionally recognized standards of care, or which are medically unnecessary.

Medicare fraud is a federal offense punishable by law, and affects suppliers, current and future Medicare beneficiaries, and taxpaying Americans alike. According to CMS, Medicare pays an estimated $60 Billion annually in fraudulent claims. Those convicted of committing fraudulent acts against the Medicare trust fund are stealing from all of us and robbing us of future benefits as promised in Title XVIII of the Social Security Act of 1965.

Fraudulent and abusive activities have created a proverbial ‘black eye’ for the DME industry. Fraud and abuse reporting will be a major component in proving to CMS that we as a supplier community are the solution as opposed to being part of the problem. It is with your help that unscrupulous suppliers committing criminal billing activities are stopped and punished to the full extent of the law. Your participation in rooting out the abuse of a federally mandate benefit is valuable and necessary in order for the Medicare system to remain solvent.

If you know of or suspect someone, or some entity is involved in fraudulent and abusive practices towards our Medicare program, please read further. The following program will allow you to easily navigate through the proper reporting process.

How to report:

To the best of your ability, please provide the following information in its entirety.

• The information provided will be forwarded to the Office of Inspector General (OIG) for review and processing
• Information will be kept in confidence and secure.
• This is a private fraud and abuse reporting site and is not to be confused with any federally operated whistle-blower program. For information on these types of programs, please contact the OIG directly.
• To fully facilitate the proper protocol for reporting fraud, certain fields of information will be required and marked with an *. Only factual and documented information will be justifiably investigated.
• Once a report has been initiated, you will be contacted with instructions on how to supply any and all evidence/back-up documentation.
• Upon completion of the complaint form, you will be issued a Fraud Report Tracking Number for use in following the investigation process.