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You are encouraged to report matters involving Medicaid fraud, waste and abuse. To assist you in combating fraud you are being provided with the following guidelines. Before you get in touch with your state Medicaid contact or call the National Fraud Hotline, please be ready to provide as much information as possible, including: The name of the Medicaid client The client's Medicaid card number The name of the doctor, hospital, or other health care provider The date of service The amount of money that Medicaid approved and/or paid A description of the acts that you suspect involves fraud or abuse relating to your allegation. Who to Contact Contact Your State Directly - Medicaid is a joint Federal and State-funded program. Although the Federal Government requires that certain persons are eligible for Medicaid benefits and sets standards for quality of care, the States carry out most of the day-to-day business of Medicaid. If you suspect that fraud is being committed against Medicaid, your first contact should be the Program Integrity contact in the agency that oversees your State's Medicaid program, which is usually called the State Medicaid Agency. Two options are provided for obtaining contact information to report fraud and abuse. One option is the State Fraud and Abuse Contact Report (click on "Related Links Inside CMS" below) which provides contact information for both the State Medicaid Agencies and the Medicaid Fraud Control Units. The other option is the State Contacts link (click on "Related Links Inside CMS" below), which connects to the CMS Contacts Database, however it only provides contact information for State Medicaid Agencies. After clicking on State Contacts, choose the respective State/Territory. For Contact Type, choose "General Professional Contact," and for Organization Type, choose "Medicaid - Report Fraud." Then, click on the "Show Contacts" button. Call the OIG National Fraud Hotline - A second way to report suspected fraud in Medicaid is to call the Office of Inspector General's (OIG) National Fraud Hotline or submit your report online. (Click "National Fraud Hotline"link below.) This hotline handles calls about both Medicaid and Medicare, but it is not as direct as calling your State contact. If you choose to use the Hot Line and/or submit online as a means of reporting fraud, you are still asked to use the guidelines listed above before you make your call. Dial 1-800-HHS-TIPS
(1-800-447-8477)
Page Last Modified: 04/05/2011 4:02:50 PM
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