How do I report a suspicious Medicare billing error without getting in trouble myself?

Question

Cynthia Nakaya · Accepted Answer

Don't let the fear of retaliation prevent you from exposing the possible wrongdoing of someone in a position of trust over you. The False Claims Act protects you.

Fraud, waste, and abuse hurts us all. It takes courage to report something you think is wrong, but it's the right thing to do. We all must do our part to expose corruption in the system because, in the end, it's our money being misused. 

To report something you think is wrong, you have several options. You can call your provider's office and inquire about the charge. They may be able to explain it. If you feel uncomfortable or sense your concern was brushed off, call your plan's member services number and speak with a supervisor about the billing error. You may also call Medicare to voice your concerns.  These actions take time, but after you call, you'll feel better knowing you did the right thing.

Lt Col Tim Brown · Answer

You can report it to the insurance company, Medicare or both.  You’re not going to get in trouble for reporting suspicious activity or out and out frauds, waste or abuse.

Gary Church · Answer

To report fraud, abuse, or billing issues, call Medicare directly at 800-633-4227. You can also report online: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse

Charise Karjala · Answer

Call 1800 Medicare for assistance.  Provide them with the information and your questions will be reviewed under compliance.

Esther Miller · Answer

You will not get in any trouble for reported suspected fraud or billing errors to Medicare. 

If you believe this is an honest billing error, contact the billing agent first to try and get it corrected. You can also contact your agent for assistance in determining if an actual billing error occurred. 

If you do suspect either fraud or wastefulness, you can contact Medicare directly at 1 800 Medicare. Your complaint is completely confidential.

Bob Greco · Answer

If you suspect a Medicare billing error with original Medicare or Medicare advantage. You can call Medicare at 1-800-MEDICARE.

Steven Bleicher · Answer

There is a law that protects folks from intimidation when it comes to a health care or Medicare-related incident or grievance. It is the “Whistleblower” regulation. No worries!

Diana Garner · Answer

You can contact the Senior Medicare Patrol (SMP) or the Office of Inspector General (OIG) hotline. Both allow for reporting without revealing personal information.

Dana Dane · Answer

Sometimes there are billing errors. In my experience, the number one error is coding something as routine when it should be coded as medically necessary. A call to your provider is usually enough to fix the problem. They simply add the correct code and rebill. If you are being charged for services not rendered or items not received, for example, I would first contact your agent. In this case, you may also contact the provider. The next step would be to report it to CMS which is Medicare.

Answered by Dana Dane on April 4, 2025

Agent Licensed in OR, AZ, CA & 6 other states

Answered by Dana Dane Medicare Insurance Agent

Mary Salmon · Answer

If you see a suspicious Medicare billing error, you should start first with the doctor or clinic to verify the charges. If necessary, you can call 1-800-MEDICARE to report it. It is important to identify fraud and abuse within Medicare.

Answered by Mary Salmon on April 22, 2025

Broker Licensed in TX & OK

Answered by Mary Salmon Medicare Insurance Agent

Joseph Peck · Answer

You can go on medicare.gov to do online or even call medicare to report it. I have helped some of my clients navigate this.

Tammy Stoner · Answer

Do not be afraid to report or call on a billing error.  

Most billing errors can be corrected with a simple phone call to the billing department. Other instances may need assistance by a Medicare representative or your insurance agent.

I am happy to help my clients fix errors and get the most of the benefits.

Joshua Ruiz · Answer

Medicare encourages beneficiaries to report fraud or billing mistakes — and you’re protected when doing so in good faith. You won’t get in trouble for reporting something suspicious, even if it turns out to be a mistake.

Call 1-800-633-4227

If you prefer, you can report without giving your name — though giving your info may help them investigate more thoroughly.

Katheryn Evans · Answer

Call the number listed on the practitioner's bill and ask questions so you understand why they are asking for that specific dollar amount to be paid.

If you are not satisfied, call your insurance company and share your concern.

If you are still not satisfied call your state insurance commissioner and CMS and file a complaint.

Heidi Delaney · Answer

The best place to start is the provider's Compliance Department, or your Medicare Advantage or Supplement carrier. If you do not get a satisfactory response within a reasonable time, you can report directly to Medicare, to your State Department of Insurance, or to the Office of Inspector General.

Answered by Heidi Delaney on July 30, 2025

Broker Licensed in CO, AZ, KS & 5 other states

Answered by Heidi Delaney Medicare Insurance Agent

Heather Borlenghi · Answer

You can call Medicare. You can call or go online to the Department of Health and Human Services. They have a fraud hotline. There is the Senior Medicare patrol that can also assist you with this. I think the best way is to contact Medicare. They can assist you and provide you with all of your options.

Answered by Heather Borlenghi on April 28, 2025

Agent Licensed in GA, AL, AR & 15 other states

Answered by Heather Borlenghi Medicare Insurance Agent

Fred Manas · Answer

If you suspect Medicare fraud or abuse without risking personal repercussions, here's how you can report it: 
1. Consider the Senior Medicare Patrol (SMP): 
SMPs are state programs funded by the federal government, providing free assistance to Medicare beneficiaries in detecting and preventing healthcare fraud and abuse.
They have staff and volunteers who can help you understand your Medicare Summary Notice (MSN), identify suspicious activity, gather evidence, and guide you through the reporting process.
You can find your local SMP program by visiting their website or calling 1-877-808-2468. 
2. Contact the appropriate agencies directly: 
Medicare: Call 1-800-MEDICARE (1-800-633-4227).
Department of Health and Human Services (HHS) Office of the Inspector General (OIG): Call their fraud hotline at 1-800-HHS-TIPS (1-800-447-8477) or file a report online. You are not required to identify yourself when reporting.
Medicare Advantage or Part D plans: If the suspected fraud involves a private Medicare Advantage or Part D plan, contact the plan directly.
State Health Insurance Assistance Program (SHIP): Visit www.shiphelp.org or call 877-839-2675 to find your local SHIP. 
3. Important Considerations:
Review your Medicare Summary Notice (MSN): Regularly review your MSN to identify services or supplies that were billed to Medicare.
Consider contacting the provider directly: If you think a charge is incorrect, you may want to call the provider's office to ask for an explanation.
Whistleblower protections: Whistleblower protections exist under the False Claims Act and other federal laws.
Anonymity: You can report Medicare fraud anonymously to agencies like the OIG and CMS. 
In summary, you have several options for reporting suspicious Medicare billing errors without getting in trouble yourself. Utilizing resources like the SMP, contacting Medicare directly, or reporting to the HHS-OIG hotline can help ensure your concerns are addressed appropriately.

Vachik Chakhbazian · Answer

begin by contacting the healthcare provider or billing department first to inquire about the error and seek resolution. If the issue persists, you can then report the error to the Medicare Administrative Contractor (MAC) or the Senior Medicare Patrol (SMP) for further investigation. You can also submit a complaint through Medicare.gov.

Answered by Vachik Chakhbazian on May 12, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Gary Henderson · Answer

Call Medicare
Anytime you see something that doesn't look correct and you've researched it with your doctor or hospital and determine it wasn't made an error, then you can contact Medicare and report it

Mike Henry · Answer

1 800 Medicare   Often times it’s a coding error by Dr’s office. Other times it’s a legitimate fraud. Anyway start with that number and check with your Dr’s office

Todd Bostic · Answer

You can contact CMS, and you would not get in any trouble as a matter of fact, it would actually be helpful if you did.

Judi Norton · Answer

You can call 800-447-8477 as an anonymous caller, or https://oig.hhs.gov/FRAUD/REPORT-FRAUD/INDEX.ASP.

Kimberly Hargis · Answer

Call the Medicare 1-800-MEDICARE helpline.

You can also report it online through Medicare.gov or through the Internet Crime Complaint Center

Ellen Diehl · Answer

To report a suspicious Medicare billing error or suspected fraud, you can call the Medicare fraud hotline at 1-800-MEDICARE 800-633-4227

Randy Hill · Answer

Here’s what to do if you spot something fishy on your Medicare bill:

1. Double-check the bill.
Look at your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).

Did you get charged for something you didn’t receive?

Did they bill the same thing twice?

Did the date look wrong?

2. Call your doctor or provider first.
Sometimes billing mistakes happen by accident.
Ask: “Can you help me understand this charge?”

3. Still looks wrong? Report it safely.
You can call Medicare’s fraud hotline at
1-800-MEDICARE (1-800-633-4227)
or
1-800-HHS-TIPS (1-800-447-8477) (Health & Human Services)

You can stay anonymous if you want and you will not get in trouble for asking questions or reporting a possible error.

Why this matters:

Medicare loses billions of dollars every year to mistakes and fraud.
When you speak up, you’re helping protect your money and everyone else’s too.

If you’d like, I can help you review your Medicare statement and make sure everything looks right no pressure, no cost.