August 7, 2020

Fighting Healthcare Fraud: Steps You Should Follow Once You Become A Victim

Healthcare fraud is such a big problem that the U.S. government is facing when it comes to Medicare. It’s a crime that involves healthcare workers, pharmaceutical companies, and medical care facilities and provides.

From the California Business Journal Newswires.

In healthcare, there’s zero transparency. That’s why false claims arise involving improper billing, such as hospitals or healthcare workers maliciously increasing the amount of declared medical procedures. If you’re a victim of healthcare fraud, you should know the next actionable steps you have to take.

Report to Medicare

It’s important to know where to report medicare fraud to ensure that you’re taking the right steps towards the resolution of the problem. For instance, you can report Medicare fraud directly to Medicare.

Here’s how to report healthcare fraud directly to Medicare:

  • Before you report healthcare fraud, make sure to get ready to provide the required information, including your name and identifying information, item or service you’re questioning, expected delivery date, the approved payment amount or paid by Medicare and the Medicare Summary Notice date.
  • You can call Medicare directly to report healthcare fraud by calling their toll-free hotline number at 1-800-MEDICARE or 1-800-633-4227). If you’re a TTY user, you can call 1-877-486-2048.
  • For those who have a Medicare Advantage Plan, they can call and report the case to the Medicare Drug Integrity Contractor or MEDIC at 1-877-7SAFERX or 1-877-772-3379.

Submit an OIG Hotline Complaint

Another way of reporting a healthcare fraud case is through the inspector general. You can submit a hotline complaint through the Office of the Inspection General of the U.S. Department of Health and Human Services. The OIG Hotline Operations accepts complaints and tips about potential fraud, abuse, mismanagement, and waste in government healthcare programs.

Here are the things you need to know before submitting a complaint via OIG Hotline:

  • You can contact the OIG Hotline through the contact form of their website.
  • Every report is highly appreciated, but due to plenty of complaints the agency receives, not every submission guarantees an investigation.

Report Private Healthcare Fraud

Private healthcare fraud refers to the dishonesty and intentional processing of false claims by healthcare workers submitted to private healthcare insurance companies.

If you suspect or a victim of private healthcare fraud, you can follow these steps:

  • Equip yourself with the right information by reading the Q&A or FAQ page of Medicare, OIG, and your insurance company’s fraud reporting section.
  • Immediately contact your insurance company if you’re a victim of private health insurance fraud.
  • Get in touch with your area’s State Insurance Fraud Bureau.
  • If you suspect Medicare fraud, such as Medicare billing fraud, you can visit STOP Medicare Fraud.
  • File a formal complaint with your area’s designated State Medical Board.

Hire a Medical Fraud Lawyer

If the healthcare fraud case is a big matter, it’s best to consult a medical fraud lawyer to help you with all the legal processes involved in reporting the incident. It’s very true if you’re not just a victim of healthcare fraud but a whistleblower.

You probably know that big pharmaceutical companies and healthcare corporations are powerful, so taking actions against them may endanger your employment, your finances, and even your life and your family’s. That’s why consulting a legal expert is a must.


Patients who are a victim of healthcare fraud can follow the above-mentioned steps to help the government stop such problems in the future. Aside from patients, previous or current employees can also report healthcare fraud to Medicare, OIG, or to a medical fraud attorney who will help the whistleblower get the necessary protection and bring the matter to the government.





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